Week 5 Practice Questions
A 14-year-old child with terminal brain cancer has months left to live. The child's pain is increasing, along with problems ambulating due to unsteady gait and increasing difficulty in swallowing. The parents ask the nurse about hospice care. Which response by the nurse is appropriate?
"Hospice care can be provided in your home." Hospice care can be provided in the patient's home or in a hospital setting, and therefore this is the best response for the nurse to make. "With hospice care, your family is able to receive respite care." A child may be admitted to the hospital when in hospice care for pain control and respite care, and therefore this is the best response for the nurse to make. "Hospice care allows for a comfortable death while ensuring the dignity of your child." Hospice care allows for a less-chaotic, home-like environment that enhances the ability to have a comfortable death. The dignity of the child is enhanced as well.
Parents of a 12-year-old child with cancer ask the nurse about the policy on discussions of death with their child. Which is the most appropriate response by the nurse?
"I will not lie to the child as lying may harm our nurse-patient relationship." The needs of the patient come first so this response provides the parents with an honest response regarding their question.
A student nurse is describing palliative care to a client's family. Which statement made by the student nurse indicates a need for correction by the registered nurse?
"Palliative care is the same as hospice care"
Doctor orders 12 mg/kg of Acyclovir. The patient weighs 115 lbs. Acyclovir is supplied as 100 mg/2 ml. How many ml will you administer per dose?
12.5 ml convert lbs to kg 115 lbs to kg divide 115 lbs by 2.2 kg 115 lbs = 52.3 kg 12 mg x 52.3 kg = 627.6 mg 100 mg / 2 ml = 627.6 mg / X cross multiply 100X = 1255.2 divide by 100 X = 12.5 ml
A child is placed on NG tube feeds, due to decreased PO intake. They are prescribing bolus feeds of 250 ml 6 times a day, to be administered over 30 minutes. What rate (ml/hr) should the feeding pump be set at for each feed?
500 ml/hr 250 ml to be administered over 30 minutes. Multiply 250 ml x 2 to get the hourly rate.
An order states: Benadryl 17mg by mouth every 6 hours as needed for itching. You have the liquid form available (12.5mg/5ml). How many ml's will you give per dose? Please round to the tenths place.
6.8 ml 17 mg / X = 12.5 mg / 5 ml cross multiply 85 = 12.5X divide by 12.5 6.8 = X
A patient weighing 19 kg is placed on maintenance IV fluids. The nurse verified that a rate of ________ ml/hr is correct before initiating fluids. Round to the nearest tenth.
60.4 ml/hr 11 to 20 kg fluid rate is 1000 ml plus 50 ml/kg for weight over 10kg. Patient weighs 19 kg = 9 kg over 10 kg. 1000 ml + 50 ml /9 kg 50 ml x 9 kg = 450 ml 1000 ml + 450 ml = 1450 ml divide by 24 for the hourly rate 1450 ml / 24 hours = 60.4 ml/hr
The nurse assessing a child with Wilms tumor knows that the
abdomen should not be palpated
A parent is taking care of her child dying of cancer and asks the nurse about oral care since the child often complains of a dry mouth. What education on oral care can the nurse provide to this parent?
"You can moisten her lips with this sponge swab." Sponge swabs provide moisture for the lips and mouth of the dying child. "Use the artificial saliva drops as needed to provide comfort." Artificial saliva drops add moisture to the mouth and provide comfort. "Petroleum jelly on the lips provides moisture for a longer period of time." Petroleum jelly or lip balm is used to treat dry, chapped lips.
The parent of a 15-year-old with terminal cancer approaches the nurse and asks what care options are available for when the child is dying. The parent states the child is very close to family and siblings and loves to be around the pet dogs. Which is the best response?
"You could use home hospice care so the child is in a comfortable and relaxed environment." Hospice care can be provided in the home and allows for a more comfortable and relaxed environment than the hospital setting.
A parent of a child who has terminal cancer is concerned with the child's weight loss due to a decrease in appetite. The parent becomes frustrated and expresses to the nurse, "My child needs to be fed; she is starving!" What is the best response?
"Your child's lack of interest in food is a normal part of the dying process." The lack of interest in food and liquids is a normal part of the dying process and a source of great distress for family members. Educating the parent on the reason for the weight loss dispels the misconception that the child is starving to death.
Match each term with its definition: Megakaryocyte
Precursor to platelets
A 4-year-old child is expected to die within the week. The child sleeps all day and has not eaten in 2 days. What should the nurse communicate to the child?
That the child will not be left alone to die. For reassurance it should be consistently and frequently communicated to the child and family members that the child won't be left alone to die. That the child is loved and supported by the nurses and family members. Children who are dying need to experience complete love and acceptance. That the illness and impending death are not the child's fault or a result of poor judgement. The dying child should be consistently reassured that the illness and approaching death are not the result of any action or omission committed by the child.
Pick the priority pre-op intervention for a child with Wilms tumor.
Avoid abdominal palpation
A sibling is noticeably upset at the death of a sister. Which is an example of an activity that allows the sibling to assist in the immediate care of the body?
The sibling washes the hands and face of the sibling alongside the nurse during death care. Care of the body immediately after death includes washing the hands and face of the deceased child.
The mother of a 14-year-old child who recently died tells the nurse that the 10-year-old sibling has become very withdrawn, angry, and aggressive. The child has said to the mother, "It should have been me." The mother asks the nurse how to respond to the child. Which responses by the nurse are appropriate?
"A child's response to death is varied because of age and developmental level." Children respond to a sibling's death in a variety of ways based on their age and developmental level. "Your child is working through the stages of grief. Sometimes a child stays in one stage longer than others." Children usually experience all 5 stages of grief, not always in order. They can also experience one stage several times as a way of coping with their feelings. This child is in the anger stage of grief. "Your child may be experiencing survivor's guilt related to the death of your child and needs to express feelings." Siblings often feel guilt for being the child who survived. Allowing the child to express feelings provides a way for those feelings to resolve.
Parents are devastated that their child is dying of cancer and express to the nurse that "they are going to do everything to keep their child alive." Which are the most appropriate responses by the nurse?
"As the child's advocate, the health care team must work together with the family to provide reasonable treatments for the child." The family and the health care team work together to remain the child's advocate with a focus on what the treatment is doing for the child versus what it is doing to the child. "Together the family and the health care team must look at the child's needs to ensure we are not prolonging or worsening the child's condition with the treatments." The health care team works with the family to be the child's advocate with a focus on what the treatment is doing for the child versus what it is doing to the child.
The mother of a 7-year-old with a brain tumor has just learned that cancer is now also found in her child's spine. Which response by the nurse addresses the mother's concerns?
"Cancer cells spread by invasion of other tissues." Cancer cells spread by invasion, in which cells grow in unrestricted, disorderly fashion at the site of origin; therefore, this is the response expected by the nurse. "Cancer cells spread by metastasis to distant body sites." Cancer cells spread by metastasis, in which the cells grow in sites other than the site of the primary cancer.
A 4-year-old patient has died and the nurse is extremely distraught because of the strong bond the nurse developed with the child. Which statement provides an example of how the nurse can cope better in the future?
"In the future I will spend equal amounts of time with each patient." Spending equal amounts of time with every patient is an example of setting professional boundaries, which prevents the formation of strong bonds with patients.
A dying child, who has been unresponsive for the past two days in hospice at the hospital, opens his eyes and softly talks to his mother. He asks his mother how she is and where his siblings are and can he see them. The mother tells the nurse, "I think he is getting better." Which response by the nurse is appropriate?
"It is not uncommon to be more alert and interested in the family right before a child dies." Children have been noted to have a surge of energy and alertness immediately before they die. Parents must be educated that this is not a sign of improvement.
A 12-year-old patient has been in hospice for one month and expresses feelings of discontent and would like to go back to the hospital. The patient states missing being with other children and liking the food there better. How will the nurse respond?
"It is okay to change your mind." The child should know that they have the right to change health care environments and that there won't be trouble for wanting to change. "Tell me more about how you are feeling." It is important to allow the child to express emotions regarding hospice care, and therefore this is the best response for the nurse to make. "I'll let your parents know you want to go back to the hospital." This demonstrates to the child that you are working on accommodating the change from hospice to the hospital setting.
A child is dying of sickle cell disease and parents are expressing concern over the large amounts of opiates needed to control the child's pain. The father states, "I am worried that my child will become addicted to the medication." Which statement by the nurse addresses this parent's concern?
"Our goal with your child is to effectively manage the pain and maintain an acceptable comfort level which may include using larger doses of opiates." Parents are often concerned about addiction problems, but when educated on pain management techniques and drug dosages, an understanding related to why large doses of opiates are utilized occurs and the concern about addiction is resolved.
A child with osteosarcoma (bone cancer) rates her pain 10/10 despite narcotic administration, has lost 20 lb since starting chemotherapy, and cries with every movement and position change. The parents approach the nurse and ask how the pain can have an emotional impact on the child. Which response by the nurse is appropriate?
"The child's thoughts of having to stay alive while living in pain are worse than the thoughts regarding dying." When a dying child works through the stages of grief, the child may reach a point where being ill is worse than dying.
Parents of a child with a terminal illness are choosing hospice care for their 7-year-old child. The child has difficulty swallowing, is bedridden, and requires frequent morphine administration to keep the pain at a 4/10 level. An interdisciplinary team meeting has been scheduled with hospice and the parents to discuss the child. The parents ask the nurse what to expect at this meeting. Which response by the nurse is appropriate?
"The health care providers, child life specialist, social workers, nurses, home health aides, case managers, and grief counselors meet to discuss your child's plan of care." The hospice team is an interdisciplinary team that focuses on all areas of care for the terminal patient. This is therefore the most appropriate response by the nurse.
Two healthy siblings of a child with chronic illness are talking with a nurse about the expected death of the child. One sibling begins to cry and the other sibling punches the crying sibling in the arm. The parent expresses concern over the differences in coping. How should the nurse respond?
Reassure the parents that differences in grieving are normal. A sibling's response to death and dying varies, and the child can experience one stage of grief many times or out of sequence. Explain what resources are available for children experiencing grief. Children who are grieving may benefit from attending support groups created just for children. Therefore this is an appropriate response for the nurse to make. Explain that grief presents differently according to the developmental stage of the child. A sibling's response to death and dying varies according to the sibling's age and developmental level.
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 (CVC) may be implanted for long-term chemotherapy administration." A CVC will likely be placed for long-term chemotherapy administration and to prevent the possibility of infection related to frequent needle sticks.
A 10-year-old child with leukemia is dying after a failed bone marrow transplant. The child is anxious when approached by the nurses, expresses fear about going to sleep at night, and cries when the parents are not present in the room. The nurse is concerned with the child's ability to cope with dying. Which actions should the nurse take next?
Stay in the room with the child while they fall asleep. A child who is dying wants to feel safe and not be alone. Staying in the room with the child while they fall asleep assists with the patient accepting death. Have a volunteer stay with the child while the parents are gone. A child who is dying will not want to be alone. Having a volunteer stay with the child while the parents are gone prevents the child from being alone.
A four-year-child with 6 months to live tells parents about angels who come to visit her at night. The parents are concerned and ask the nurse how they should handle this. What is the nurse's best response?
"This is a normal response for a 4-year-old child who is terminally ill. Continue to allow the child to share the experiences with you." The responses and actions of the dying child are affected by such things as visions of angels and are considered to be normal responses for the child.
A 4-year-old child is dying of an inoperable brain tumor. The child is conscious for only a few hours out of every day and doesn't talk much when awake. The parents tell the nurse what the child has told them. "Don't be sad when I die. I will go to sleep and then wake up and be here with you." The parents ask the nurse how to respond to the child's statements. Which response by the nurse is appropriate?
"Your child's perception of death is that death is reversible and temporary and is appropriate for the developmental age." In early childhood, children are at the preoperational cognitive stage and perceive death as reversible and temporary.
Match the listed cancer treatment with its corresponding purpose: Replace conventional therapy based on current scientific research
CAM therapies
Match the white blood cell with its function: T-cell
Cell-mediated immunity
What are the cardiovascular signs that death of a child is approaching?
Cool hands and feet Cardiovascular changes affect the extremities first and are related to the changes in cardiac functioning. Cooler extremities will be an expected finding in patients who are about to die. Weak peripheral pulses Pulses and blood pressure may become difficult or impossible to palpate when the child's death is approaching. Cyanosis in the hands and feet Cardiovascular changes affect the extremities first and are related to the changes in cardiac functioning. This can lead to a decrease in oxygen supply to the extremities.
Which nursing diagnosis is highest priority for a child undergoing chemo with nausea and vomiting?
Fluid and electrolyte balance
Which of the following foods should a child with neutropenia avoid?
Fruit salad
The function of the RBC is to carry oxygen to the tissues. Which factor is essential for the RBC to complete this task?
Hemoglobin Hemoglobin is essential to ensure oxygen is carried to the body tissues by red blood cells. Oxygen binds to the iron found within the hemoglobin, which helps to facilitate the delivery of oxygen.
Match the term with its definition: Erythropoietin
Hormone that stimulates red blood cell production and maturation
Match the white blood cell with its function: B-cell
Humoral immunity (antibody production)
The nurse is preparing a 4-year-old for bone scintigraphy. Which action is appropriate for the nurse to take?
Provide mild sedative to the patient if ordered A sedative may be provided for small children because bone scintigraphy requires them to lie still for 45-60 minutes during the procedure.
Match the term with its definition: Erythrocyte
Red blood cell
Match each term with its definition: Thrombocyte
Small, irregular shaped, non-nucleated fragments
Match the listed cancer treatment with its corresponding purpose: An adjunct for nausea control
Steroid therapy
The nurse wishes to educate parents on what to expect as the child is approaching death. Which response regarding the child's breathing pattern is most appropriate?
The child will have Cheyne-Stokes respirations, leading to respiratory arrest. Cheyne-Stokes respirations is a cyclic period of slowing respirations with apnea, followed by an increased respiratory rate to a peak, and then slowing into apnea again. The respirations are associated with impending respiratory arrest.
Which mechanism immediately follows tissue injury?
Vessel spasm The immediate response of a blood vessel to injury is vasoconstriction or vascular spasm.
Which vitamin can most affect the clotting process?
Vitamin K Vitamin K is essential since it affects the clotting process—it is essential for the production of four distinct clotting factors: prothrombin, and factors VII, IX, and X.
Leukemia is a cancer of:
White blood cells
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." Radiation therapy is used to eradicate the tumor by killing cancer cells. "To promote bone marrow suppression." Radiation therapy is used to suppress bone marrow prior to bone marrow and stem cell transplantation. "To prevent further growth of the cancer cells." Radiation therapy can be used as palliative therapy to prevent further tumor growth.
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 Chemotherapy causes damage to rapidly growing cells, including platelets, which can lead to bruising and bleeding. A platelet level will help identify the severity of the patient's thrombocytopenia.
A mother discusses options about hospice care for an only child who has three months to live. The child has osteosarcoma (bone cancer) and has had frequent admissions to the hospital for pain control. The mother states they live on a farm 30 miles from the hospital. Which piece of information is most important in influencing the decision for hospital-based hospice care?
The family lives 30 miles from the hospital. The family lives quite a distance away from the health care facility. This could make home hospice care difficult as resources are limited, and it is a great distance to obtain medical assistance.
A 5-year-old patient with a terminal illness is expressing sadness and confusion about dying. What can the nurse do to help the child cope and understand the dying process?
Read the book "Fall of Freddy the Leaf" with the child. Reading a book about death and dying to the child may provide information on dying that decreases the patient's confusion. Review the dying process using appropriate terms with the child when the child is awake. Using appropriate terms when reviewing the dying process with the child may decrease the sadness and confusion experienced by the patient. Access the Children's Hospice International website for information on hospice for the child. The Children's Hospice International website is an excellent resource for the nurse to use to obtain information regarding pediatric hospice, palliative care, and end-of-life care. Information from this site may assist in decreasing the confusion experienced by the patient in relation to death and dying.
List the steps of RBC production in the proper order.
Decrease in circulating oxygen Kidneys produce erythropoietin RBC precursors produced in the bone marrow Rapid maturation leads to development of RBCs Hypoxia and hypoxemia stimulates the release of erythropoietin in the kidneys. Erythropoietin, produced in the kidneys, stimulates the bone marrow to produce RBC precursors that mature quickly.
Which patients are at risk for impaired clotting?
Diagnosis of osteosarcoma Megakaryocytes are produced in the bone marrow. Conditions that affect the bones can lead to impaired clotting. Diagnosis of liver failure cirrhosis Conditions that affect liver function can lead to impaired clotting because the liver produces the clotting factors necessary for hematopoiesis. A patient with Von Willebrand disease Dairy is often a primary source of calcium, which is necessary for clot formation. A lack of dietary calcium can contribute to impaired clotting.
A young child is admitted to the pediatric unit with a diagnosis of Wilms tumor. Considering the unique needs of a child with this diagnosis, what statement should be on a sign placed by the nurse at the child's bedside?
Do not palpate the abdomen
Which manifestation would the nurse include when the parents of a child who has just been diagnosed with hemophilia ask what symptoms of bleeding they should look for in the future? Select all that apply
Nosebleeds Easy bruising Blood in urine Painful and swollen joints
Pallaitive care focuses on....
Quality of life Supporting the child and family Symptom management Supportive care
The nurse is caring for a child being treated for acute lymphocytic leukemia (ALL). Laboratory results indicate that the child has a white blood cell count of 5000/mm^3 with 5% segs and 3% bands. Which of the following analyses is most appropriate?
The absolute neutrophil count is 400/mm^3, and the child is neutropenic. ANC = (% neutrophils + % bands) x WBC / 100 (5% + 3%) x 5,000/mm^3 = 40,000 40,000 / 100 = 400 ANC = 400/mm^3 An ANC between 2,500 and 6,000 is considered normal while anything below 1,000 is considered abnormal. Because this patient's ANC is 400 they are considered neutropenic.
A young nurse developed a friendship with a teenaged patient who died. What can this nurse expect during the grieving process?
The grieving process for the nurse may take a lot longer to get over. When a nurse becomes more involved with a patient, a more intense response or a delay in the resolution of grief may occur.
A nurse is tending to the emotional needs of the parents who have just lost a child. What is an example of the type of communication necessary during this time?
The nurse tells the family members that the nurse is available to talk if they desire and will return when needed or requested. The nurse should provide privacy for the family but remain close by and return as needed or requested.
Which scenario accurately reflects a parent experiencing anticipatory grief?
The parents cry when holding their sleeping child. Crying when hold a sleeping child is an example of anticipatory grief, a response to the impending death of a loved one.
A patient is dying with a rare disorder and an autopsy will be required. At what stage of the dying process will the parents be notified that an autopsy will occur?
The parents should be made aware of the autopsy request prior to the death of the child. Families should be provided information before the child's death because it affects their time and involvement with their child after death occurs.
Why is the size and structure of the red blood cell important?
The shape and flexibility allows for passage through the blood vessels. Red blood cells are biconcave, flexible discs, which allows for easy passage through small capillaries.
What is the most common cause of anemia?
Too little iron in the blood
A 14 year old child with terminal brain cancer has months left to live. The child's pain is increasing along with problems ambulating due to unsteady gait and increasing difficulty in swallowing. The parents ask the nurse about hospice care. Which response by the nurse is appropriate? Select all that apply
With hospice care, your child doesn't have to be admitted to the hospital Hospice care can be provided in your home Hospice care allows for a comfortable death while ensuring the dignity of your child With hospice care, some of the physical and emotional burdens of caring for your child are taken care of
A 4-year-old child with chronic sickle cell crisis is terminal and unable to walk, requires continuous oxygen administration, is moaning and crying with position changes, and has refused to eat meals for the last 2 days. The parents ask the nurse how they will care for their child and what they should do now. Which response by the nurse is appropriate?
"Learning about hospice care services would be appropriate at this time." The goal of hospice care is to improve the quality of life and decrease the stress on the child and family members and can be introduced at any time during the child's treatment.
The hospice nurse is caring for a school-aged child who has a glioblastoma with metastasis throughout the body. The toddler has been declining in health for the past 7 days, has had no oral intake, has a labored, irregular respiratory rate of 6 breaths per minute and is bradycardic at 50 bpm. The parents ask the nurse what they can do to help the child through the process. Which is an appropriate response by the nurse?
"Tell the child it is ok to die." The child may be hanging on to life because the child cannot die without permission by the parents. The parents must convey feelings of love to child, a sense that child will be missed, and finally give the child permission to die.
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." Young children may need to be sedated prior to a PET scan because they will need to remain still during the procedure.
Administration of diphenhydramine can help with which physiologic response expected near the time of death?
Death rattle Diphenhydramine may be given to decrease the amount of secretions found in the oral airway of the child, which will decrease the death rattle heard with respiration.
A nurse is caring for a child and notices that as the child's last days are approaching, the family is becoming more withdrawn. Which action is most important to ensure the child is not left alone during the dying process?
Discuss the need to talk to the child, touch the child, and remain at the bedside of the child during the last days. The dying child needs to experience complete love and acceptance and know that they will not be left alone to die. Discussing the expectations with the parents provides them with how to interact with their child before the child dies and may decrease their withdrawnness.
Match the white blood cell with its function: Monocyte
Fight chronic infection
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. Autologous stem cell transplantation is performed by infusing stem cells into the patient's peripheral blood supply. BMT requires bone marrow to be placed directly into the bone.
The nurse is caring for a 17-year-old who has been ill for many years. The child is told that she is expected to have 12 months left to live. What action by the nurse is most appropriate?
Support the child as they experience feelings of denial. Denial is often the first reaction of the grieving process experienced by individuals going through the dying process. The nurse can expect that this will likely be the first response of the child that the nurse will provide care for.
A young nurse who does not deal well with death is looking for support. What is the best way a more experienced nurse can respond?
The experienced nurse offers to mentor the young nurse. Mentoring the young nurse provides the support the nurse needs while learning how to deal with death and dying. Inform the young nurse about availability and time to talk. Meeting with a nurse and taking the time to listen shows support for what that nurse is experiencing. The experienced nurse refers the young nurse to grief programs offered at the hospital. Providing a resource for dealing with grief demonstrates support and concern for the young nurse. Grief programs are important for health care professionals to use to repair, maintain, or enhance their emotional well-being.
Which scenario reflects the type of interaction allowed in the hospital moments after a child passes away?
The family members remain in the room with the child immediately following the death of the child and the nurse provides privacy. Family members should have the opportunity to spend time with their child, even before the body is cleaned.
True or False The neutropenic febrile child should receive intravenous broad-spectrum antibiotics immediately.
True
When preparing a child to receive chemotherapy, the nurse can expect to see which values in the patient's electronic health record?
WBC levels WBC levels should be obtained prior to chemotherapy. This provides a baseline for comparison once treatment has begun.
Which is an example of an activity that can help the child who is going through the dying process?
Writing a letter to the child's mother and father. Memories can be created for the family through the writing of letters by the child. A child life specialist can assist with this activity if the child requires assistance with writing. Journaling about a favorite memory with the family. Journaling provides memories for the child and family member to read throughout the dying process. It is a lasting memory for the family members after the child has died. Creating a scrapbook of pictures from the last family vacation. Memories can be created for the child and family through creating a scrapbook of pictures from past family events.
Match the white blood cell with its function: Basophil
Activate inflammatory response
A preschool-age child undergoing chemo experiences nausea and vomiting. What intervention would be best?
Allow the child to choose what to eat for meals
A patient's chest x-ray reveals inflammation of the bronchi and a sputum culture is positive for streptococcus. Which white blood cells may be active?
B cells B cells participate in both inflammatory and immune actions. T cells T cells participate in both inflammatory and immune actions. Monocytes Monocytes participate in both inflammatory and immune actions. Lymphocytes Lymphocytes participate in both inflammatory and immune actions. Natural killer cells Natural killer cells participate in both inflammatory and immune actions.
Pick the priority intervention for the dying child experiencing increased pain.
Analgesics
The nurse is caring for a child with suspected cancer. Which signs and symptoms should the nurse expect to note on assessment?
Fatigue Although fatigue is a nonspecific symptom, it is considered a covert manifestation of pediatric cancer and should therefore be noted by the nurse. Headache Although headache is a nonspecific symptom, it is considered a covert manifestation of pediatric cancer and would be expected by the nurse during an assessment. Weight loss Weight loss is an overt sign of pediatric cancer, and would be an expected finding in a child with cancer. Lymphadenopathy Although lymphadenopathy is a nonspecific symptom, it is considered a covert manifestation of pediatric cancer and therefore expected by the nurse during the assessment.
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 Gum inflammation, nausea and gastroesophageal reflux disease (GERD) are side effects of chemotherapy treatment. Alopecia, or hair loss, is also a side effect of chemotherapy.
Which conditions can lead to anemia?
Liver laceration A liver laceration can lead to a reduced volume of packed RBCs, and thus anemia. Iron-deficient diet An iron-deficient diet can cause a reduction in circulating hemoglobin, and thus anemia. Heavy menstrual bleeding Heavy menstrual bleeding can lead to a reduced volume of packed RBCs, and thus anemia.
Match each term with its definition: Hemostasis
Prevention of blood loss
Match each term with its definition: Fibrinogen
Protein necessary for clotting
Match the term with its definition: Hematopoiesis
Red blood cell production
The structure of red blood cells supports ease of flow through the blood vessels. Which patient condition is most likely to inhibit blood flow?
Sickle cell anemia The altered shape of the RBC in patients with sickle cell anemia can lead to impaired flow through the capillaries, which is why sickle cell patients can present with intense pain or "sickle cell crisis."
True or False A child has only 2 options for cod status: AND (allow natural death) and full code
False
The child with early stage leukemia is least likely to present with which symptom.
Palpable tumor
Match the listed cancer treatment with its corresponding purpose: Enhance cell recovery
Biologic agents
Place the steps of clot formation in the order in which they occur.
Damaged tissue and platelets release factors that stimulate a series of reactions involving the activation of clotting factors Prothrombin converted to thrombin Fibrinogen converted to fibrin Fibrin mesh forms, blood stops flowing Clot retracts, site is sealed When tissue is damaged, platelets and factors are released that stimulate prothrombin to convert to thrombin and fibrinogen to convert to fibrin. Fibrin mesh forms over the area of damage, causing blood to stop flowing—this then retracts and seals the site.
An oncology nurse experiences exhaustion at the end of every shift and is looking for a way to cope. Which is an example of the best way the nurse's needs can be met?
Encourage the nurse to talk with other nurses about what they are experiencing Discussing feelings with coworkers demonstrates concern, respect and support for the nurse. Mutual support of each other is important for nurses who work with terminally ill children.
A 5-year-old child has been placed in hospice care for terminal cancer. The child overhears the parents discussing a local hospice center for placement of the child. The child asks the nurse, "Why do I have to go away? I don't want to be away from my parents and pets." What action should the nurse take in response to the child's concern?
Discuss the option of home hospice care with the parents, after sharing the concerns of the child with them. Hospice at home allows the child to remain at home and have family, pets, and friends around the child. The home environment provides familiarity and comfort to the child.
David, 15 mos, is recovering from surgery to remove Wilms tumor. Which best indicates that he is free from pain?
Increased interest in play
The nurse is treating a child who is approaching death within hours. Which respiratory responses are likely findings in a child who is approaching death?
Apneic episodes of 40 seconds between respirations Periods of apnea increase as death approaches, and therefore this can be expected. Retraction of muscles under the sternum and ribcage Increased work of breathing is evident by retractions and is associated with impending death. Loud sighing at the end of each respiration with a loud rattle noise The death rattle is associated with secretions in the upper airway that cannot be cleared by the child.
Which granulocyte would be most active during an acute bacterial pneumonia?
Neutrophil Neutrophils are the primary defense against bacterial infections. Neutrophils are an important part of the innate immune system and will be most active during an acute bacterial infection.
Absolute Neutrophil Count (ANC)
ANC = (% neutrophils + % bands) x WBC / 100
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 Anemia is a sign of malignancy and would support a diagnosis of cancer in a child with epistaxis, weight loss, and diarrhea. Mass in the child's neck Lymphadenopathy, or swollen lymph nodes, may manifest as a mass in the child's neck and is a sign of malignancy. This would support a diagnosis of cancer in a child with epistaxis, weight loss, and diarrhea.
Match each term with its definition: Vasoconstriction
Blood vessels decrease in diameter
Which term best describes the shape of sickled cells?
crescent
Match the term with its definition: Polycythemia
Increased production of red blood cells
The parents of a 4-year-old child have decided to try an herbal remedy to help relieve their child's suffering. After observing this, what should the nurse do next?
Research the herb to see if it is appropriate to use. The nurse must ensure that there are no harmful effects of the herbal supplement. Provide emotional support and comfort to the family members. Use of alternative therapy may provide hope to the patient and family. Emotional support and comfort aids in providing hope to the family and patient. Report the herbal supplement use to the primary care provider. The health care provider should be aware of all of the treatments utilized by the patient. Interactions between drug and herbal supplements may occur, so the provider should know everything the patient is utilizing.
A 9 month old with iron deficiency anemia is crawling around on the floor. Which would determine the child is tolerating the activity?
Respiratory rate of 42
True or False Pediatric patients at the end of life will often have feelings of guilt.
True
True or False Tumor lysis syndrome can occur in patients with leukemia.
True
An 11 year old female child is experiencing a vaso-occlusive sickle cell crisis. She is receiving IV fluids, supplemental oxygen and analgesics. Which finding in this child most indicates the treatment plan of care is effective?
Verbalization of a decrease in complaints of pain
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 (CVC) or implanted port may be implanted for long-term chemotherapy administration."
True or False A patient with sickle cell anemia should be placed on fluid restriction during a pain crisis.
False
True or False A pediatric patient's Code Status is always either a Full Code or Allow Natural Death.
False
True or False A toddler can have as much cows milk as he or she would like.
False
True or False Neuroblastoma is a cancer that impacts the brain
False
True or False Non-Hodgkin's Lymphoma is often associated with Epstein-Barr virus.
False
A child has cancer and has been treated with chemotherapy. The most recent lab value indicates that the white blood cell count is very low. Based on this result, which would the nurse expect to administer?
Filgrastim (Neupogen)
Nursing care of the child who is immunosuppressed due to chemotherapy administration should always include which of the following?
Good hand washing
Which is the most common type of bleeding disorder, accounting for 80% of all hemophilia cases?
Hemophilia A
A 5 year old is newly diagnosed with an astrocytoma brain tumor. His symptoms include headache, nausea, and seizures. Based on this information, which nursing diagnosis would be most appropriate for him?
High risk for injury
Tumor lysis syndrome causes severe metabolic abnormalities including which of the following?
Hyperphosphatemia Hyperkalemia Hypocalcaemia Hyperuricemia
Which of the following lab results would the nurse expect to see in a patient suffering from Tumor Lysis Syndrome? Select all that apply
Hypocalcemia Hyperuricemia Hyperkalemia Hyperphosphatemia
A child being treated with chemotherapy is admitted to the hospital for fever and possible sepsis. Which of the following should we expect as admission orders? Select all that apply
Obtain blood cultures Administer antibiotics Administer acetaminophen
A child is seen in the pediatrician's office for complaints of bone and joint pain. Which other assessment finding may suggest leukemia?
Petechiae
At the end of every shift a nurse feels drained and begins crying, grieving the loss of patients. What can the nurse do to increase coping mechanisms?
Ask a more experienced pediatric nurse to mentor the nurse. Mentoring provides support to the nurse who is struggling with the grief associated with losing patients. Obtain at least 8 hours of uninterrupted sleep every night. Obtaining the proper number of hours of uninterrupted sleep allows the nurse to take care of own physical health, which assists with increasing coping mechanisms. Meet monthly with other pediatric nurses to discuss the past month's events. Expressing feelings with other nurses provides support to the nurse who is struggling with the grief associated with losing patients.
Platelets survive in the bloodstream for approximately 10 days. Identify causes of a platelet's shorter life span.
Bacterial pneumonia Infection can shorten a platelet's lifespan since the bacteria induce platelet activation. Once a platelet is activated, it becomes the target of phagocytes that begin to break down the cell. Bacteria also have cytotoxic compounds that induce apoptosis of the platelet. Stage 2 hepatic cancer Disease can shorten a platelet's lifespan since it affects the health of the liver, which is responsible for clotting factor production, and can affect overall health of the body and production of healthy megakaryocytes. Temperature 104 degrees Fahrenheit Fever can shorten a platelet's lifespan since the increased temperature creates an environment that is not favorable to the platelet's survival.
A patient develops hives and begins wheezing immediately after being stung by a bee. Which white blood cells are active at this time?
Eosinophils Eosinophils are most active through an allergic hypersensitivity reaction.
Which situation identifies an environment in which a child may be at increased risk of developing cancer?
Exposure to radiation from repeated computed tomography (CT) scans Exposure to radiation can increase a child's risk of developing cancer.
A 7-year-old child has recently died after being treated for leukemia for the past 5 years. The child was unresponsive for days prior to dying and the parents were at the bedside the entire time. The nurse overhears the parents say statements such as, "I feel like this is a dream. I don't know what to do now." "Thank God it is finally over; he's at peace." "Is it wrong to feel this way?" Which emotions or reactions are being expressed?
Indifference to activities of daily living Emptiness and lack of interest in activities can be displayed as indifference to many aspects of daily living in someone who has experienced a great loss, such as the death of a child. Relief that the child is no longer suffering Parents may be relieved when the child is no longer suffering physically and emotionally, and therefore it is normal for the parents to express these emotions. Numbness to any emotions when around others Numbness may be displayed by parents whose child has just died. It is an expected emotion for parents who have lost a child. Guilt related to being relieved over the death of the child Parents may feel guilt related to the relief experienced when the child died, and therefore this is an expected statement for the parents to make.
A mother of a dying 14-year-old is trying to decide whether to order a do not attempt resuscitation (DNAR) order on her child. Which are the next best actions for the nurse to take?
Inform the mother that the DNAR order can be stopped at any time. A DNAR order can be revoked at any time, and therefore the nurse should inform the mother. Inform the mother that DNAR order prevents interventions from being performed after the child stops breathing. A DNAR order does prevent chest compressions, ventilations, and advance life support treatments from being initiated when the patient's breathing or heartbeat ceases.
A child has passed away and it is now time to clean the body. Which should the nurse do next?
Invite the parents and siblings to assist in preparing the body Including the family in the final act of care for the child may provide a means of closure for them, and therefore this is an appropriate action for the nurse to take.
What is the purpose in allowing family members to interact with the body after the patient dies?
It allows the family members to say their final good-byes. Allowing interaction with the body after the patient dies allows for emotional closure for the family members, which is important for grieving.
Which environment would the nurse prepare for a child in the dying process?
Low lighting and soft music playing. The goal of nursing care for the dying child is to create a calm and peaceful environment. Quiet space away from a lot of activity. The goal of nursing care include creating a quiet and secluded environment. Multiple opportunities to create cherishing moments. Creating memories allows the family to spend time together, which become a source of comfort after the child dies. An environment conducive to allowing family members to stay with the child. One of the goals of nursing care for the dying child is to allow family members to stay with the child.
A family has decided to gather in the room of a child who has impending death. A prayer has started and then all the family members begin praying and laying their hands on the patient. What action will the nurse take?
Observe the child for restlessness, moaning, or increased muscle tension. Restlessness, moaning, and increased muscle tension demonstrate increased agitation and could negatively impact the child's comfort level.
Which medical conditions may affect the patient's ability to produce red blood cells?
Osteomyelitis Red blood cells are produced in the bone marrow. Osteomyelitis can lead to a decreased production of red blood cells. Osteosarcoma Red blood cells are produced in the bone marrow. Osteosarcoma can lead to a decreased production of red blood cells. Chronic renal failure Erythropoietin is produced in the kidneys. Kidney failure can decrease the production of the hormone, and lead to decreased ability to produce red blood cells.
Which patient findings would have an associated effect on the white blood cell function?
Osteosarcoma White blood cells are produced in the bone marrow. Conditions that affect the bone marrow can lead to impaired white blood cell production. Bacterial pneumonia An infection such as bacterial pneumonia would cause an increase in production of WBC. Enlarged cervical lymph nodes White blood cells are produced in the lymphatic tissue. Enlarged cervical lymph nodes indicate an infection. A viral infection can decrease your WBC count and a bacterial infection can increase your WBC count.
Which white blood cell processes assist with immunity?
Phagocytosis Monocytes and macrophages are responsible for phagocytosis of large cells. They help to rid the body of foreign organisms. Antibody production White blood cells contribute to antibody production during infection.
