Ch 46 Ricci: Pediatric Cancer

The nurse is reviewing the results of a clotting study for a healthy 6-year-old. What would the nurse document as a normal prothrombin finding? 6.0 to 9.0 seconds 11.0 to 13.0 seconds 16.0 to 18.0 seconds 21.0 to 35.0 seconds

11.0 to 13.0 seconds The nurse would identify a prothrombin time of 11.0 to 13.0 seconds as normal for a healthy child. A result of 21.0 to 35.0 seconds would be the expected range for partial thromboplastin time and activated partial thromboplastin time. Findings of 6.0 to 9.0 seconds and 16.0 to 18.0 seconds are outside the normal range.

The nurse is caring for a child in sickle cell crisis. To best promote hemodilution, the nurse would expect to administer how much fluid per day intravenously or orally? 130 ml/kg of fluids per day 110 ml/kg of fluids 150 ml/kg of fluids 120 ml/kg of fluids per day

150 ml/kg of fluids To promote hemodilution in sickle cell crisis, the nurse would provide 150 ml/kg of fluids per day or as much as double maintenance, either orally or intravenously.

A parent calls the pediatric oncology clinic about the child having headaches after chemotherapy. What is the nurse's best advice? Administer oral hydrocodone as needed. Use an ice pack on the child's head. Administer ibuprofen every 6 hours. Administer acetaminophen as needed.

Administer acetaminophen as needed. Caution parents, while children are receiving chemotherapy, not to give them nonsteroidal anti-inflammatory drugs because they may interfere with blood coagulation, a problem that may already be present because of lowered thrombocyte levels. Instead, suggest they use acetaminophen to relieve a headache. Ice packs are used to prevent hair loss and do not help with headaches. Hydrocodone is not needed for a headache.

A teenage girl asks why chemotherapy causes hair loss. Which response by the nurse is accurate? Chemotherapy affects cancer cells and normal cells that multiply rapidly. Circulation to the head causes large doses of chemotherapy to reach the scalp. Hair is not a living tissue, and it is easily damaged by chemotherapy. Hair is exposed to the sun, which increases sensitivity to chemotherapy

Chemotherapy affects cancer cells and normal cells that multiply rapidly. Chemotherapy is cytotoxic to rapidly proliferating cells—malignant or normal. Normal cells that turn over rapidly include those of bone marrow, hair, and mucous membranes.

A nurse is preparing a 7-year-old girl for bone marrow aspiration. Which site should she prepare? Femur Sternum Anterior tibia Iliac crest

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 15-year-old boy has been diagnosed with an osteosarcoma of the distal femur. He also demonstrates a chronic cough, dyspnea, and chest pain, along with chronic leg pain. Based on these findings, the nurse should suspect metastasis to which body area? Lungs Rib cage Brain Heart

Lungs Metastasis occurs early with bone tumors because of the extensive vascular system in bones. Metastasis to the lungs is very common; as many as 25% of adolescents will have lung metastasis already by the time of initial diagnosis. When this is present, the adolescent usually has noticed a chronic cough, dyspnea, and chest pain in addition to chronic leg pain. Other common sites of metastasis are brain and other bone tissue.

The 2-year-old child receiving treatment for a cancer diagnosis is seen for a well-child checkup. Which health maintenance activity will the nurse exclude? teaching the importance of taking water safety measures plotting height and weight on a growth chart administering the measles, mumps, rubella (MMR) vaccine assessing dietary intake by addressing "picky eating" and "food jags"

administering the measles, mumps, rubella (MMR) vaccine Live vaccines (viral or bacterial) should not be administered to an immunosuppressed child because of the risk of causing disease. The other health maintenance activities are important for the health maintenance of the child and should be included during the well-child visit.

The nurse is caring for a 6-year-old girl with leukemia who is having an oncologic emergency. Which signs and symptoms would indicate hyperleukocytosis? tachycardia and respiratory distress bradycardia and distinct S1 and S2 sounds respiratory distress and poor perfusion wheezing and diminished breath sounds

tachycardia and respiratory distress Increased heart rate, murmur, and respiratory distress are symptoms of hyperleukocytosis (high white blood cell count) which is associated with leukemia. Increased heart rate and blood pressure are indicative of tumor lysis syndrome, which may occur with acute lymphoblastic leukemia, lymphoma, and neuroblastoma. Wheezing and diminished breath sounds are signs of superior vena cava syndrome related to non-Hodgkin's lymphoma or neuroblastoma. Respiratory distress and poor perfusion are symptoms of massive hepatomegaly which is caused by a neuroblastoma filling a large portion of the abdominal cavity.

Question 5 of 5 A child receiving chemotherapy wants to have a large birthday party and invite all the classmates. When the parent asks the nurse about this, how should the nurse respond? "It is better to avoid large groups right now." "What about taking your child to a movie instead?" "We can have the party here in the hospital play room." "That will be a good way to cheer your child up!"

"It is better to avoid large groups right now." A child receiving chemotherapy is particularly susceptible to contracting an infection and thus should be kept away from people with known infections. Therefore, having the child avoid large groups right now is best. Although it would possibly cheer up the client, it is not best for the client's health. Going to a movie would not be a good idea because it could lead to exposure to someone who is ill. A party in the hospital playroom is a possibility for the children in the hospital, but it would not be possible to invite the child's entire class.

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.

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 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." "I bought the medication to give to her when she says she is in pain." "She loves popsicles, so I'll let her have them as a snack or for dessert."

"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 14-year-old client scheduled for magnetic resonance imaging (MRI). The nurse explains the test to the child and family. Which information would be most appropriate to include in the explanation? "The MRI uses radio waves and magnets to produce a computerized image of the body." "The MRI is a nuclear scanning test to rule out cancer involving the bones or determine extent of bone involvement." "The MRI uses radiation to examine soft tissue and bony structures of the body." "The MRI uses sound waves to create images that visualize body structures and locate masses."

"The MRI uses radio waves and magnets to produce a computerized image of the body." The MRI uses radio waves and magnets to produce a computerized image of the body. The bone scan is a nuclear scanning test to rule out cancer involving the bones or determine extent of bone involvement. The ultrasound uses sound waves to create images that visualize body structures and locate masses. Radiography uses radiation to examine soft tissue and bony structures of the body.

The parents of a child diagnosed with cerebral astrocytoma ask the nurse about their child's prognosis. Which response by the nurse would be most appropriate? "Survival is variable from several months to ten years or longer. Children who have a complete resection have the best prognosis." "The survival rate is greater than 95% with radiation and complete surgical resection." "There is a poor overall prognosis with a survival rate less than 10% and a median survival time of 2 years." "The prognosis is favorable with complete surgical resection and the child usually experiences minimal neurologic deficits post-operatively."

"The prognosis is favorable with complete surgical resection and the child usually experiences minimal neurologic deficits post-operatively." Cerebral astrocytomas account for approximately 25% of all types of astrocytomas. The prognosis is favorable with complete surgical resection, and patients have minimal neurologic deficits post-operatively.

The parents of a child diagnosed with rhabdomyosarcoma ask the nurse to explain what this means. What is the nurse's best response? "There is a tumor in the bone." "There is a tumor in the eye." "This is a tumor of the kidney." "The tumor is in the muscle."

"The tumor is in the muscle." A rhabdomyosarcoma is a tumor of striated muscle. A nephroblastoma (Wilms tumor) is a malignant tumor that rises from the metanephric mesoderm cells of the upper pole of the kidney. Retinoblastoma is a malignant tumor of the retina of the eye. Ewing sarcoma occurs in the bone.

A child is to receive an oral corticosteroid as part of the treatment regimen for leukemia. After teaching the child and family about this drug, the nurse determines the need for additional teaching when they state: "He might develop a rounded face from this drug." "We should administer the drug on an empty stomach." "We should check our son's urine for glucose." "We will need to gradually decrease the dosage."

"We should administer the drug on an empty stomach." Corticosteroids are commonly administered with food to decrease the risk for gastrointestinal upset. Corticosteroids can disrupt glucose balance, so urine should be checked for glucose. A moon face is an adverse effect of corticosteroids. Corticosteroids need to be tapered gradually to reduce the risk of adrenal insufficiency.

The nurse is working with a child who is in sickle cell crisis. Treatment and nursing care for this child include which actions? Select all that apply. Promoting exercise and activity Administering platelets Administering oxygen Administering analgesics Maintaining fluid intake

Administering oxygen Administering analgesics Maintaining fluid intake A vaso-occlusive crisis occurs when sickle-shaped cells are clumped together in a joint or organ. This causes severe pain and hypoxia to the tissues. The management for a vaso-occlusive crisis is to provide adequate pain relief, oxygen to correct the hypoxemia, and increased IV fluids to thin out viscosity and allow the cells to flow in the vascular system. Platelet administration is not indicated as part of the treatment. Children and adults experiencing a sickle cell crisis experience a high degree of pain, so exercise and activity is postponed until the crisis is over. Activity is encouraged when the child is not in crisis as it promotes growth and a positive self-image.

The nurse will use a special needle to start intravenous (IV) fluids through which central venous access device? An implanted port A tunneled central catheter A multilumen catheter A peripherally inserted central catheter

An implanted port An implanted port requires a special (Huber) needle placed through the skin into the port, which is implanted surgically under the skin and over a bony prominence. The peripherally inserted central catheter (PICC) and tunneled catheters (Broviac, Hickman, Groshong) do not require a special needle for access. A multilumen catheter has more than one lumen but is not a port.

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? Analgesic Antiemetic Antineoplastic 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.

A 4-year-old child diagnosed with Wilms tumor is admitted for surgery. What information would be most important for the nurse to include in the child's preoperative plan of care? Administering analgesics for pain Preparing the child for amputation Performing dressing changes to the affected area Avoiding further abdominal palpation

Avoiding further abdominal palpation After the initial assessment is performed on a child with Wilms tumor, further palpation of the abdomen should be avoided because the tumor is highly vascular and soft. Therefore, excessive handling of the tumor may result in tumor seeding and metastasis. Preoperatively, the child with Wilms tumor does not have a wound; therefore, dressing changes are not necessary. Although the child may experience abdominal pain, avoiding further abdominal palpation would be the priority. Surgical removal of the tumor and affected kidney is the treatment of choice for Wilms tumor. Amputation would be more likely for a child with osteosarcoma.

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? Bladder Blood Brain Kidney

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.

What is one advantage of an implanted port (central venous access device) that the nurse will explain to an adolescent? Flushing of the device is not necessary. No tunneling is needed when the port is inserted. Body appearance changes very little. No special procedure is necessary for removal.

Body appearance changes very little. An implanted port has nothing extending through the skin and may be obvious only as a slight protrusion at the insertion site. Some tunneling from the port to a central vein is needed. Removal of the port requires a surgical procedure. Flushing of the port is necessary when used and on a regular basis.

How can the nurse most simply describe for distressed parents a rhabdomyosarcoma that has been found in their 5-year-old? Explain that it develops in nerves outside the brain and spinal cord Indicate that the more commonly used name is Hodgkin lymphoma Describe it as a bone tumor Call it a tumor of muscle tissue

Call it a tumor of muscle tissue A rhabdomyosarcoma is a tumor of striated muscle that most commonly develops in the head, neck, arms, and legs, as well as in the genitourinary tract, of children.

A nursing student compares and contrasts childhood and adult cancers. Which statement does so accurately? 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. Environmental and lifestyle influences in children are strong, unlike those in adults. Little is known regarding cancer prevention in adults, although much prevention information is available for 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.

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

Christmas factor Factor IX is also known as plasma thromboplastin component or Christmas factor. Its function is to activate factor X. Factor X is the Stuart factor. Stuart factor's function is to activate factor II in the clotting cascade. Factor VIII is the antihemophilic factor. It is a platelet cofactor and also helps activate factor X. Factor VII is proconvertin. It is considered a stable factor and also acts to activate factor X.

The nurse is caring for a 10-year-old girl with iron toxicity. What would the nurse expect the physician to order? Succimer Deferasirox Dimercaprol Edetate calcium disodium

Deferasirox Deferasirox is indicated for iron toxicity. It binds with iron, which is removed via the kidneys. Dimercaprol is indicated for blood lead levels greater than 45 mcg/dl. It removes lead from soft tissues and bone, allowing for its excretion via the renal system. Edetate calcium disodium is indicated for blood lead levels greater than 45 mcg/dl. The medication removes lead from soft tissues and bone, allowing for its excretion via the renal system. Succimer is indicated for blood lead levels greater than 45 mcg/dl; it removes lead from soft tissues and bone, allowing for its excretion via the renal system.

An adolescent receiving chemotherapy has lost all hair and is sad about self-image. Which action should the nurse take to support this adolescent and involve the client in decision making? Encourage the adolescent to select hats or wigs to fit one's personality. Have a Child Life specialist work with the adolescent. Support the adolescent's choice of comfortable clothing. Refer the adolescent to a peer support group.

Encourage the adolescent to select hats or wigs to fit one's personality. A positive body image is important, especially to an adolescent. It is important for the nurse to acknowledge the adolescent's feelings of sadness over the body changes caused by the illness. To help the adolescent have some power over the illness, the nurse should encourage the adolescent to choose wigs, hats, or scarves that fit his or her personality or even meet a goal of doing something the adolescent would not have dared to before. This could be a wig of different hair color or a big floppy hat with sequins. Whatever the choice, this gives the adolescent a feeling of being in control of the situation and able to make the decisions. Nurses should support the adolescent's choice of clothing. Most likely the adolescent will choose clothing for comfort. Loose clothing disguises weight loss or scarring while promoting self-esteem. Referring the adolescent to a support group or the help of a Child Life specialist are good interventions. Both will help the adolescent work through the feelings of loss, but neither gives the adolescent the ability to make decisions about outward appearance.

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

Erythrocytes Leukocytes Thrombocytes The formed elements, the erythrocytes, leukocytes, and thrombocytes are the portions of the blood most commonly affected by hematologic disorders in children. Plasma and whole blood are not major sites of hematologic disease.

The mother of an 11-year-old girl who will begin radiation therapy soon asks the nurse what the family needs to do for their daughter during this time. Which interventions are most important? Select all that apply. Increase amounts of fresh fruit and vegetables rich in cellulose Apply skin creams and lotions to irradiated skin Administer antiemetics as prescribed Encourage lengthy soaks in the bath Help the child devise "mind games" to play during the procedure Expose the irradiated area to air

Expose the irradiated area to air Administer antiemetics as prescribed Help the child devise "mind games" to play during the procedure To care for the child who is receiving radiation therapy, the family should expose irradiated area to air but not to direct heat or sunlight, administer antiemetics as prescribed, and help the child devise "mind games" to play during the procedure, among other things. Because some skin preparations are drying and some interfere with radiation, do not apply creams or lotions unless prescribed. Avoid lengthy soaks in bath water or swimming pools. Reduce amounts of fresh fruit and vegetables rich in cellulose, and eliminate apple juice from the child's diet, because these may contribute to diarrhea and subsequent fluid loss.

A toddler who is beginning to walk has fallen and hit his head on the corner of a low table. The caregiver has been unable to stop the bleeding and brings the child to the pediatric clinic. The nurse is gathering data during the admission process and notes several bruises and swollen joints. A diagnosis of hemophilia is confirmed. This child most likely has a deficiency of which blood factor? Factor X Factor XIII Factor V Factor VIII

Factor VIII The most common types of hemophilia are factor VIII deficiency and factor IX deficiency, which are inherited as sex-linked recessive traits, with transmission to male offspring by carrier females.

While administering a blood transfusion to a child with a hematologic disorder, the nurse notes the child develops urticaria and wheezing. Which collaborative interventions will the nurse begin? Select all that apply. Obtain a blood culture. Give an antihistamine. Administer a diuretic. Discontinue the transfusion. Apply oxygen as needed.

Give an antihistamine. Apply oxygen as needed. Discontinue the transfusion. The child is experiencing signs of an allergic reaction to the blood transfusion and would require discontinuation of the blood transfusion, administration of an antihistamine, and oxygen as needed. Diuretics would be needed for an anaphylactic or circulatory overload reaction related to the blood transfusion, whereas a blood culture would be needed if a contaminant in the blood was suspected.

The nurse assesses that the client is at risk for an infection related to chemotherapy-induced immunosuppression. What will the nurse include in the teaching plan for the child and parents to help reduce this risk? Select all that apply. Provide a low-carbohydrate, low-protein diet. Have the child sleep in a single bed and room. Cheer up the environment with fresh flowers and plants. Encourage frequent contact with multiple visitors. Encourage frequent, thorough handwashing.

Have the child sleep in a single bed and room. Encourage frequent, thorough handwashing. To reduce the risk for 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.

Which nursing diagnosis would be most appropriate for a child with idiopathic thrombocytopenic purpura? Risk for infection related to abnormal immune system Ineffective breathing pattern related to decreased white blood count Ineffective tissue perfusion related to poor platelet formation Risk for altered urinary elimination related to kidney impairment

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 white blood cells. It occurs when there is decreased red blood cells. The child who develops ITP has no different immune system than other children who are healthy.

A child with hypoplastic anemia develops hemosiderosis. What nursing instruction promotes the treatment goals? Administer daily doses of ferrous sulfate Adhere to a strict schedule of prednisone Infuse deferoxamine at home Avoid all products containing aspirin

Infuse deferoxamine at home Treatment of anemia is through transfusion of packed red blood cells to increase erythrocyte levels. As a result of the necessary number of transfusions, hemosiderosis or the deposition of iron in body tissue can occur. Treatment for hemosiderosis is iron chelation through the use of subcutaneous infusions of deferoxamine. These infusions are to be given at home overnight for 5 to 6 nights per week. There is not enough information to determine if aspirin should be avoided. Ferrous sulfate will add more iron to the child's body and should be avoided. Children with congenital hypoplastic anemia may receive corticosteroid therapy along with transfusions of packed RBCs to raise erythrocyte levels.

The nurse is preparing the medication leucovorin to provide to a child who is currently receiving methotrexate for a brain tumor. What should the nurse explain to the child and parents regarding the purpose of this medication? It prevents methotrexate that is not incorporated into leukemia cells from entering normal cells. It is an experimental drug to ensure resistance to infection during methotrexate therapy. It will encourage bone marrow to build new cells after methotrexate therapy. It helps methotrexate enter leukemia cells the same as insulin helps glucose enter cells.

It prevents methotrexate that is not incorporated into leukemia cells from entering normal cells. A drug such as leucovorin, often called leucovorin rescue, may be administered after systemic methotrexate to neutralize its action and protect normal cells from the effect of the drug. Leucovorin is not used to encourage the growth of new cells in the bone marrow. It does not facilitate the use of methotrexate in the cells. Leucovorin is not an experimental drug used to improve resistance to infection.

A school-aged child with cancer is receiving chemotherapy. Which nursing action would best promote the oral comfort of a child receiving chemotherapy? Keeping the child's lips moist with petroleum jelly to prohibit cracking Having the child solely eat or drink cold foods to reduce mucosal pain Encouraging the use of acidic fruit juices to decrease mouth organisms Vigorously brushing the teeth and gums to remove secretions

Keeping the child's lips moist with petroleum jelly to prohibit cracking The mouth of a child receiving chemotherapy can become very inflamed and painful. It is important for the nurse to assess the oral cavity for redness, lesions, and plaques frequently. If the child is NPO, ice chips can be used to provide hydration to the mucosa. It is important to use a soft-bristle toothbrush when brushing the teeth. Excessive pressure on the gums will cause bleeding. If the gums are very inflamed, the child may use a saltwater solution or commercial mouthwash to keep the mouth clean. Instruct the child that this may cause burning. If burning or stinging occurs then discontinue the practice and provide solutions with pain medication. Using a petroleum product on the lips will provide hydration to the lips and keep them from being irritated or cracking. Drinking cold or hot foods will cause more pain in the mouth and may cause further irritation. Acidic fruit juices will cause increased pain and irritation in the mouth and may cause more inflammation.

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. Monitor the site dressing and vital signs. Evaluate pain and administer medication.

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 caring for a 6-year-old boy with non-Hodgkin lymphoma who is being treated with monoclonal antibodies. What recommendation would the nurse include in the child's plan of care? Assessing the child's hydration status secondary to vomiting. Monitoring for complaints of bone pain. Assessing for signs of capillary leak syndrome. Monitoring for allergic reactions or anaphylaxis.

Monitoring for allergic reactions or anaphylaxis. The nurse would monitor for infusion-related reactions and anaphylaxis if monoclonal antibodies were administered and would have epinephrine, antihistamines, and steroids available at the bedside for treatment if a reaction occurred. Assessing the level of hydration due to vomiting would be necessary if tumor necrosis factor was administered. The flu-like symptoms produced by interferons also require hydration maintenance. Monitoring for complaints of bone pain is appropriate when administering colony-stimulating factors such as filgrastim or sargramostim. Assessing for signs of capillary leak syndrome within 2 to 12 hours of the start of treatment is necessary when interleukins are used.

When planning the care for a child with leukemia who is receiving methotrexate, the nurse would assess the child closely for which possible effect? paresthesias of the fingers cushingoid facial appearance weight gain mucositis

mucositis Mucositis, or ulcers of the gum line and mucous membranes of the mouth, is a frequent side effect of methotrexate. Cushingoid facial appearance and weight gain are associated with the use of prednisone. Paresthesias are associated with vincristine.

A 5-year-old boy is diagnosed with congenital aplastic anemia. Which symptoms should be considered when developing the plan of care? Select all that apply. Bradypnea Bradycardia Cyanosis Pallor Fatigue Easy bruising

Pallor Fatigue Easy bruising Cyanosis When symptoms begin, a child appears pale, fatigues easily, and has anorexia from the lowered RBC count and tissue hypoxia. Because of reduced platelet formation (thrombocytopenia), the child bruises easily or develops petechiae (pinpoint, macular, purplish-red spots caused by intradermal or submucous hemorrhage). A child may have excessive nosebleeds or gastrointestinal bleeding. As a result of a decrease in WBCs (neutropenia) a child may contract an increased number of infections and respond poorly to antibiotic therapy. Observe closely for signs of cardiac decompensation such as tachycardia (not bradycardia), tachypnea (not bradypnea), shortness of breath, or cyanosis from the long-term increased workload of all these effects on the heart.

A nurse is providing care to a toddler with nephroblastoma and is being evaluated. Which nursing action would be most important? Restricting the child's visitors Placing a "no abdominal palpation" sign above the child's bed Preparing the child for chemotherapy Preventing weight-bearing activities Ensuring that the child be allowed nothing by mouth

Placing a "no abdominal palpation" sign above the child's bed Nephroblastoma (Wilms tumor) metastasizes rapidly, so it is important that the child's abdomen not be palpated any more than necessary for diagnosis, because handling appears to aid metastasis. There is no need to restrict the child's visitors. Ensuring nothing by mouth would be appropriate prior to surgery. Preventing weight-bearing activities would be appropriate for a child with Ewing sarcoma.

Which intervention is best to use with the 6-year-old who has developed stomatitis as a side effect of chemotherapy? Practice frequent, gentle oral hygiene Limit foods to cool, clear liquids Use lidocaine rinses Have the child freely choose desired foods and beverages

Practice frequent, gentle oral hygiene Frequent, gentle oral hygiene will keep the vulnerable oral mucosa clean and will prevent secondary infection. Offering only cool, clear liquids will limit nutrition. Freely choosing foods and beverages gives some control to the 6-year-old but is likely to result in ingestion of foods that are irritating to the mouth, lips, and throat. Lidocaine used as a rinse can create risks for children younger than 8 years because often some is swallowed, and this inhibits the gag reflex.

A child is undergoing a series of diagnostic tests for a suspected malignancy. Which diagnostic test result is only present in Hodgkin disease? Reed-Sternberg cells megakaryocyte cells T-lymphocyte surface markers elevated lymphocytes

Reed-Sternberg cells With Hodgkin disease, lymphocytes proliferate in the lymph glands, and special Reed-Sternberg cells (large, multinucleated cells that are probably nonfunctioning monocyte-macrophage cells) develop. Although these lymphocytes are capable of DNA synthesis and mitotic division, they are abnormal because they lack both B- and T-lymphocyte surface markers and cannot produce immunoglobulins as do usual B-lymphocytes. There will be elevated lymphocytes, but this is present in leukemias as well. T-lymphocyte surface markers are lacking in Hodgkin disease. Megakaryocyte cells are normal cells in the bone marrow and produce platelets.

When developing the postoperative plan of care for a child with sickle cell anemia who has undergone a splenectomy, which would the nurse identify as the priority? Deficient fluid volume Impaired skin integrity Risk for infection Risk for delayed growth and development

Risk for infection Removal of the spleen places the child at significant risk for infection. Although the child's skin integrity is disrupted due to the surgery, this is not the priority nursing diagnosis. Loss of fluids occurs during surgery and adequate hydration is important to prevent a sickle cell crisis, but this diagnosis is not the priority in the postoperative period. Although the child is at risk for delayed growth and development, the priority postoperatively is to prevent infection.

A couple is expecting a child. The fetus undergoes genetic testing and the couple discover the fetus has sickle cell disease. The couple ask the nurse how most commonly happens. Which statement is accurate for the nurse to provide? "Sickle cell disease is passed to a fetus when both parents have the gene." "Sickle cell diseas can be passed to the fetus in many ways. We will know more at birth." "Sickle cell disease is passed to a fetus when one of the parents has the gene." "Sickle cell disease occurs from a random genetic mutation."

Sickle cell disease is passed to a fetus when both parents have the gene." Sickle cell disease is an inherited disease. The recessive gene is passed from both parents who either have the disease or the trait. There is no need for further testing to determine the cause. There are no other ways to pass the disease other than through genetics. Informing the parents that the gene was passed from both parents is most informative. Sickle cell anemia is not a dominant disease, which is passed when only one parent has the gene, nor is caused by a random mutation.

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

Thalassemia In the child with thalassemia the skin may appear bronze-colored or jaundiced. The child with hemophilia may have bruised areas on the skin. The skin color in children with sickle cell disease may be pale in color, and with Kawasaki disease the child may have a rash on the trunk and extremities.

A 13-year-old, diagnosed with beta-thalassemia major is seen in the pediatric clinic. The nurse completes an assessment and notes that the client is below the 10th percentile in height for age. What assumption can the nurse make based on this information? The client is due for a growth spurt and should catch up in height. This finding is a common manifestation of the client's diagnosis. Further assessment of the nutritional status is warranted. The client should be referred for further evaluation.

This finding is a common manifestation of the client's diagnosis. Short stature is a common manifestation of thalassemia major. Because short stature is a common manifestation of the disorder, a nutritional assessment is not warranted. While growth spurts can occur at this age, the client will probably not catch up, because the short stature is due to the thalassemia.

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 10,000/mm3, hemoglobin 7.9 g/dl (79 g/L), hematocrit 28%, platelets 151,000/mm3. Which nursing action is priority? Provide the family with preoperative instructions. Administer antibiotics intravenously stat. Transfuse 1 unit of packed red blood cells. Ask the child to rate pain on a scale 0 to 10.

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.

Which mechanism is central to cancers in children? cellular growth race genetics environment

cellular growth Certain pediatric malignancies clearly occur at times of peak physical growth and cellular maturation. This coincidence suggests that cellular growth and development are central to the mechanism of cancer in children. By contrast, environmental exposures are a primary component of carcinogenesis in adults. Genetics and race are not commonly identified as related to pediatric cancers.

The nurse will select which meal as the best choice for a child with iron-deficiency anemia? two slices of pepperoni pizza and a glass of skim milk chicken breast, French fries, and sweetened tea peanut butter sandwich, cheese stick, and applesauce cheeseburger, broccoli, and fresh strawberries

cheeseburger, broccoli, and fresh strawberries Children with iron-deficiency anemia require diets rich in iron and vitamin C (vitamin C enhances iron absorption). Meats are excellent sources of iron. Broccoli is a good source of iron, and strawberries are a good source of vitamin C. To help the body absorb the most iron from the meal, tea and foods rich in calcium (such as milk and cheese) should be avoided.

A nurse caring for an 8-year-old child with a bleeding disorder documents the following nursing diagnosis: Ineffective tissue perfusion related to intravascular thrombosis and hemorrhage. This nursing diagnosis would be most appropriate for a child diagnosed with which condition? iron-deficiency anemia disseminated intravascular coagulation hemophilia von Willebrand disease

disseminated intravascular coagulation Disseminated intravascular coagulation (DIC) is an acquired coagulopathy that, paradoxically, is characterized by both thrombosis and hemorrhage. The outcome for this client is: The child will maintain adequate tissue perfusion of all body systems affected by DIC and regain adequate laboratory values for hemostasis. von Willebrand disease and hemophilia involve hemorrhage but not thrombosis. Iron deficiency anemia does not involve either hemorrhage or thrombosis

The nurse is assessing the laboratory results of a child receiving chemotherapy. Which agent should the nurse anticipate administering to this child after noting a significant reduction in red blood cells (RBCs)? 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.

After teaching a group of students about hemophilia, the instructor determines that the students have understood the information when they identify hemophilia A as involving a problem with: factor VIII. platelets. plasmin. factor IX.

factor VIII. In hemophilia A, the problem is with factor VIII, and in hemophilia B the problem lies with factor IX. Platelets are problematic in idiopathic thrombocytopenic purpura (ITP). Plasmin is involved in the pathophysiologic events of disseminated intravascular coagulation.

The nurse is providing care for a 13-year-old child diagnosed with iron-deficiency anemia. The client's current hemoglobin level is 11 g/dL (110 g/L). Which intervention will the nurse anticipate including in the client's care? packed red blood cell transfusions providing a high dose of intravenous immunoglobulin weekly giving ferrous sulfate with orange juice between meals increasing the daily intake of fresh fruits and vegetables

giving ferrous sulfate with orange juice between meals Treatment for iron-deficiency anemia is the administration of ferrous sulfate for a 13-year-old client with a hemoglobin at 11 g/dL (110 g/L). It should be administered with orange juice, because vitamin C helps absorb iron. It should not be taken with milk. It can cause teeth staining in children and should be given with a straw. Intravenous immunoglobulin would be administered for idiopathic thrombocytopenic purpura. The client's hemoglobin level is not severe enough to warrant blood transfusions at this time. There is also no indication the child is symptomatic. Anemia is generally diagnosed for a hemoglobin less than 12 g/dL (120 g/L) in children 12 to 14 years of age. The normal level for children 12 to 18 years of age is 14 g/dL (140 g/L). While increasing fresh fruits and vegetables is good for the client's overall health, this client needs foods specifically high in iron. These include broccoli, bananas, tomatoes, spinach, liver, nuts, dates, legumes, beef, eggs, and pork.

A child has undergone a hematopoietic stem cell transplant. When assessing the child, the nurse notes the development of a maculopapular rash on the child's palms and bottoms of the feet. Which condition would the nurse suspect? disseminated intravascular coagulation graft failure veno-occlusive disease graft-versus-host disease

graft-versus-host disease Graft-versus-host disease involves the development of a maculopapular rash on the palmar and plantar surfaces of the hand and feet evolving into erythematous rash over most of body (ranging from slight redness of the skin to complete skin desquamation). Disseminated intravascular coagulation would involve signs of bleeding, including bruising, petechiae, and ecchymoses. Graft failure would be manifested by fever, infection, and a decrease in blood counts. Veno-occlusive disease would be manifested by sudden, unexpected weight gain, thrombocytopenia, jaundice, hepatomegaly, right upper quadrant pain, ascites, and encephalopathy.

A school nurse is teaching a group of parents about signs and symptoms of cancer in children. Which symptom is an early sign of a brain tumor? nystagmus, ataxia, and seizures headache, vision changes, and vomiting projectile vomiting, lethargy, and coma headache, epistaxis, and dizziness

headache, vision changes, and vomiting Children with any form of brain tumor develop symptoms of increased intracranial pressure: headache, vision changes, vomiting, an enlarging head circumference, or papilledema. Lethargy, projectile vomiting, and coma are late signs. Epistaxis is not usually related to a brain tumor. A growing tumor produces specific localized signs, such as nystagmus (constant horizontal movement of the eye) or visual field defects. As tumor growth continues, symptoms of ataxia, personality change (e.g., emotional lability, irritability), and seizures may occur. These would be later symptoms.

A 12-year-old child is admitted to the hospital with a diagnosis of sickle cell crisis. The nurse has completed an assessment and is creating a plan of care. What aspect of the plan of care is most important to the client's outcome? age-appropriate distractions as a pain-relief strategy analgesics administered on a set schedule instead of as needed maintain the hemoglobin level at 10 g/dL (100 g/L) increasing the daily fluid intake

increasing the daily fluid intake Hydration is paramount to resolving a sickle cell crisis. Administering analgesics on a set schedule versus an as-needed schedule will help keep the pain at a manageable level. The hemoglobin level during a crisis can be as low as 6 g/dL (60 g/L). To get to 10 g/dL (100 g/L), the client would need to be transfused. Using age-appropriate distractions as pain relief may not be effective during a crisis initially.

A child with cancer is dying and in hospice care. When developing the plan of care, which intervention should the nurse include as the primary focus? keeping the child pain-free providing emotional support managing the symptoms of dyspnea delivering appropriate developmental care

keeping the child pain-free Children die from cancer. They may die at home or in the hospital, and hospice care can be provided in either setting. Children with terminal cancer often experience a great deal of pain, particularly when death is imminent. The primary goal of caring for a dying child is the prevention and alleviation of pain. The nurse would work with the parents to determine the pharmacologic and nonpharmacologic methods which work best. Many times, dyspnea and agitation can occur as a result of pain. These symptoms are reduced with pain management. Any care to the child, even in hospice care, should be developmentally appropriate. Emotional support is a necessity, both for the child and the parents, but pain relief is the priority.

A nurse is caring for a child with Hodgkin disease who is in the induction phase of a chemotherapy regimen. The nurse explains to the parents that the goal of this phase is to: kill enough cancerous cells to induce remission. destroy any residual cancer cells. destroy any remaining cancer cells. follow up for recurrent disease or late effects.

kill enough cancerous cells to induce remission. During induction, the initial phase, intensive therapy is given to kill enough cancerous cells to induce a remission. In the consolidation phase, intensive therapy is given to destroy remaining cancer cells. The maintenance phase is a designated period during which treatment is continued to destroy any residual cancer cells. During the observation phase, therapy has ended and the child is followed up for recurrent disease or late effects of treatment.

To prevent further sickle cell crisis, the nurse would advise the parents of a child with sickle cell anemia to: encourage the child to participate in school activities, such as long-distance running. administer an iron supplement daily. notify a health care provider if the child develops an upper respiratory infection. prevent the child from drinking an excess amount of fluids per day.

notify a health care provider if the child develops an upper respiratory infection. Infections caused by the Streptococcus pneumoniae can be lethal to a child with sickle cell, because they can cause overwhelming sepsis or meningitis. By 2 months of age the child should be started on Penicillin V as prophylaxis against pneumococcal infections. The child should receive the 7 valent pneumococcal series in infancy. After 2 years of age the child should receive the 23 valent pneumococcal vaccine. He or she should also be immunized against meningitis. Participating in strenuous activities such as running and limiting the amount of fluids leads to a reduction of oxygen and dehydration. This can lead to the increased sickling of cells. The anemia of sickle cell disease is not the result of iron deficiency. It is the result of the abnormal shape of the red blood cell. Administering iron will not correct the anemia.

The nurse is reviewing the medical record of a child diagnosed with Hodgkin lymphoma at the asymptomatic stage. Which would the nurse identify as typically the first sign reported by the child? night sweats weight loss anorexia painless, enlarged lymph node

painless, enlarged lymph node Children with Hodgkin lymphoma typically present with swollen, painless, and rubbery-feeling lymph nodes in the cervical or supraclavicular region. Depending on the extent of the disease at diagnosis, other symptoms may be present. However, this child was diagnosed in stage I (asymptomatic). If the lymph nodes of the chest are involved, the child has moved to the symptomatic stages and may experience dyspnea and cough. Chest pain may result from the pressure exerted by the enlarged nodes. General symptoms can also include fever, drenching night sweats, and weight loss.

A 14-year-old girl who is a vegetarian has recently developed anemia. Blood smear results show large, fragile, immature erythrocytes. She claims to take an iron supplement regularly and is surprised to learn that she is anemic, as she is otherwise healthy. As the nurse considers all of the data in the case, which anemia will the nurse discuss when collaborating with the primary healthcare provider? iron deficiency vitamin B12 deficiency sickle-cell disorder acute blood loss

vitamin B12 deficiency Vitamin B12 is necessary for the maturation of RBCs. Pernicious anemia results from deficiency or inability to use the vitamin, resulting in RBCs that appear abnormally large and are immature megaloblasts (nucleated immature red cells). Thus, pernicious anemia is one of the megaloblastic anemias. In children, the cause is more often lack of ingestion of vitamin B12 rather than poor absorption. Adolescents may be deficient in vitamin B12 if they have a long-term, poorly formulated vegetarian diet, as the vitamin is found primarily in foods of animal origin. Since the client is taking iron, iron deficiency anemia is ruled out. The blood cells in a client with sickle cell anemia are crescent-shaped and do not display the characteristics noted. There are no symptoms of blood loss or acute bleeding, as the client is otherwise healthy.

A 3-year old child is brought to the emergency department by the parents. Assessment reveals bruising and bleeding from the nose and mouth. The nurse suspects which condition? von Willebrand disease (vWD) chronic iron deficiency anemia hemophilia disseminated intravascular coagulation (DIC)

von Willebrand disease (vWD) The primary clinical manifestations of vWD are bruising and mucous membrane bleeding from the nose, mouth, and gastrointestinal tract. Bleeding associated with vWD may be severe and lead to anemia and shock, but deep bleeding into joints and muscles, like that seen in hemophilia, is rare except with type III vWD.