Blueprint Week 14

A 4-year-old child diagnosed with leukemia is hospitalized for chemotherapy. The child is fearful of the hospitalization. Which nursing intervention should be implemented to alleviate the child's fears? 1. Encourage the child's parents to stay with the child. 2. Encourage play with other children of the same age. 3. Advise the family to visit only during the sched- uled visiting hours. 4. Provide a private room, allowing the child to bring favorite toys from home.

1 Rationale: Although the preschooler already may be spending sometime away from parents at a daycare center or preschool, illness adds a stressor that makes separation more difficult. The child may ask repeatedly when parents will be coming for a visit or may constantly want to call the parents.

The nurse analyzes the laboratory values of a child with leukemia who is receiving chemotherapy. The nurse notes that the platelet count is 19,500 mm3 (19.5 Â 10^9/L). On the basis of this laboratory result, which intervention should the nurse include in the plan of care? 1. Initiate bleeding precautions. 2. Monitor closely for signs of infection. 3. Monitor the temperature every 4 hours. 4. Initiate protective isolation precautions.

1 Rationale: Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia).

The nurse is monitoring a child for bleeding after surgery for removal of a brain tumor. The nurse checks the head dressing for the presence of blood and notes a colorless drainage on the back of the dressing. Which intervention should the nurse per- form immediately? 1. Reinforce the dressing. 2. Notify the health care provider (HCP). 3. Document the findings and continue to monitor. 4. Circle the area of drainage and continue to monitor.

2 Rationale: Colorless drainage on the dressing in a child after craniotomy indicates the presence of cerebrospinal fluid and should be reported to the HCP immediately.

A child undergoes surgical removal of a brain tumor. During the postoperative period, the nurse notes that the child is restless, the pulse rate is ele- vated, and the blood pressure has decreased signif- icantly from the baseline value. The nurse suspects that the child is in shock. Which is the most appro- priate nursing action? 1. Place the child in a supine position. 2. Notify the health care provider (HCP). 3. Place the child in Trendelenburg position. 4. Increase the flow rate of the intravenous fluids.

2 Rationale: In the event of shock, the HCP is notified immedi- ately before the nurse changes the child's position or increases intravenous fluids. After craniotomy, a child is never placed in the supine or Trendelenburg position because it increases intra- cranial pressure (ICP) and the risk of bleeding. The head of the bed should be elevated. Increasing intravenous fluids can cause an increase in ICP.

The nurse is preparing to care for a dying client, and several family members are at the client's bed- side. Which therapeutic techniques should the nurse use when communicating with the family? Select all that apply. 1. Discourage reminiscing. 2. Make the decisions for the family. 3. Encourage expression of feelings, concerns, and fears. 4. Explain everything that is happening to all family members. 5. Touch and hold the client's or family mem- ber's hand if appropriate. 6. Be honest and let the client and family know they will not be abandoned by the nurse.

3,5,6 Rationale: The nurse must determine whether there is a spokesperson for the family and how much the client and fam- ily want to know. The nurse needs to allow the family and client the opportunity for informed choices and assist with the decision-making process if asked. The nurse should encourage expression of feelings, concerns, and fears and reminiscing. The nurse needs to be honest and let the client and family know they will not be abandoned. The nurse should touch and hold the client's or family member's hand, if appropriate.

Nursing interventions and medical treatments for a child with leukemia are based on what three physiologic problems?

Anemia (decreased erythrocytes); infection (neutropenia); bleeding thrombocytopenia (decreased platelets)

A client has been told of a positive breast biopsy report. She asks no questions and leaves the health care provider's office. She is overheard telling her husband, "The doctor didn't find a thing." What coping style is operating at this stage of grief?

Denial

What are the priorities for a client with a Wilms tumor?

Protect the child from injury to the encapsulated tumor. Prepare the family and child for surgery.

Mrs. Green lost her husband 3 years ago. She has not disturbed any of his belongings and continues to set a place at the table for him nightly. Is this response indicative of a normal or a complicated grief reaction?

This is a dysfunctional grief reaction. Mrs. Green has never moved out of the denial stage of her grief work.

Your client, an incest survivor, is speaking of her deceased father, the perpetrator. "He was a wonderful man, so good and kind. Everyone thought so." What would be the most useful intervention at this time?

Gently point out both the positive and negative aspects of her relationship with her father. Try to minimize the idealization of the deceased.

The nurse is monitoring a 3-year-old child for signs and symptoms of increased intracranial pressure (ICP) after a craniotomy. The nurse plans to mon- itor for which early sign or symptom of increased ICP? 1. Vomiting 2. Bulging anterior fontanel 3. Increasing head circumference 4. Complaints of a frontal headache

1 Rationale: The brain, although well protected by the solid bony cranium, is highly susceptible to pressure that may accu- mulate within the enclosure. Volume and pressure must remain constant within the brain.A change in the size of the brain, such as occurs with edema or increased volume of intracranial blood or cerebrospinal fluid without a compensatory change, leads to an increase in ICP, which may be life-threatening. Vomiting, an early sign of increased ICP, can become excessive as pressure builds up and stimulates the medulla in the brainstem, which housesthevomitingcenter.

The mother of a 4-year-old child tells the pediatric nurse that the child's abdomen seems to be swol- len. During further assessment, the mother tells the nurse that the child is eating well and that the activity level of the child is unchanged. The nurse, suspecting the possibility of Wilms' tumor, should avoid which during the physical assessment? 1. Palpating the abdomen for a mass 2. Assessing the urine for the presence of hematuria 3. Monitoring the temperature for the presence of fever 4. Monitoring the blood pressure for the presence of hypertension

1 Rationale: Wilms'tumor is the most common intraabdominal and kidney tumor of childhood. If Wilms'tumor is suspected, the tumor mass should not be palpated by the nurse. Excessive manipulation can cause seeding of the tumor and spread of the cancerous cells. Hematuria, fever, and hypertension are clinical manifestations associated with Wilms' tumor

A 4-year-old child is admitted to the hospital for abdominal pain. The mother reports that the child has been pale and excessively tired and is bruising easily. On physical examination, lymphadenopathy and hepatosplenomegaly are noted. Diagnosticstudies are being performed because acute lymphocytic leukemia is suspected. The nurse determinesthat which laboratory result confirms the diagnosis? 1. Lumbar puncture showing no blast cells 2. Bone marrow biopsy showing blast cells 3. Platelet count of 350,000 mm3 (350 Â 10^9/L) 4. White blood cell count 4500 mm3 (4.5 Â 10^9/L)

2 Rationale: Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. The confirmatory test for leukemia is microscopic examination of bone marrow obtained by bone marrow aspirate and biopsy, which is considered positive if blast cells are present.

A 6-year-old child with leukemia is hospitalized and is receiving combination chemotherapy. Lab- oratory results indicate that the child is neutropenic, and protective isolation procedures are initiated. The grandmother of the child visits and brings a fresh bouquet of flowers picked from her garden, and asks the nurse for a vase for the flowers. Which response should the nurse provide to the grandmother? 1."I have a vase in the utility room, and I will get it for you." 2. "I will get the vase and wash it well before you put the flowers in it." 3. "The flowers from your garden are beautiful, but should not be placed in the child's room at this time." 4. "When you bring the flowers into the room, place them on the bedside stand as far away from the child as possible."

3 Rationale: Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia). For a hospitalized neutropenic child,flowers or plants should not be kept in the room because standing water and damp soil harbor Aspergillus and Pseudomonas aeruginosa, to which the child is suscep- tible. In addition, fresh fruits and vegetables harbor molds and should be avoided until the white blood cell count increases.

Identify the five stages of death and dying.

Denial, anger, bargaining, depression, acceptance

Your client feels responsible for his sister's death because he took her to the hospital where she died. "If I hadn't taken her there, they couldn't have killed her." It has been 1 month since her death. Is this response indicative of a normal or a complicated grief reaction?

This is a normal expression of the anger and guilt that occur.Try to minimize rumination on these thoughts.