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

Parents ask why their child just diagnosed with leukemia needs a "spinal tap." Which is the best response by the nurse?

"Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system."

What is the best response by the nurse to the parents of a child with leukemia who express guilt because they did not take immediate action when their child seemed to develop one respiratory infection after another?

"Keep in mind that the signs of leukemia are often subtle and difficult to recognize."

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."

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."

A 9-year-old child with leukemia is scheduled to undergo an allogenic hematopoietic stem cell transplant. When teaching the child and parents, what information would the nurse include?

"We'll need to have a match to a donor."

When explaining the procedure of bone marrow aspiration to a child with leukemia, what would be the best explanation?

"You will feel pressure on your hip from the needle."

Examination of a child reveals a palpable abdominal mass. A diagnosis of neuroblastoma is suspected. When reviewing the child's history and physical examination, which would the nurse expect to find? Select all that apply.

- Flushing - Constipation

The nurse identifies the nursing diagnosis of risk for infection related to chemotherapy-induced immunosuppression. What would the nurse include in the teaching plan for the child and parents about reducing the child's risk? Select all that apply.

- Having the child sleep in a single bed and room - Encouraging frequent, thorough handwashing

A child has been diagnosed with acute lymphocytic leukemia (ALL). The nurse knows that which possible complication can occur? Select all that apply.

- blindness - renal impairment - infections - epistaxis - bone pain - infertility

A group of newly hired nurses who will be working on the pediatric unit are attending an in-service program about sickle cell disease. During the program, the nurse manager describes the steps for managing sickle cell pain. Place these steps in the sequence in which the nurse manager would describe them.

1. Assess the pain. 2. Believe the child's report of pain. 3. Look for complications or cause of pain. 4. Give medications and use distraction. 5. Provide rest in a quiet area. 6. Administer fluids.

The nurse is assessing children in an ambulatory clinic. Which child would be most likely to have iron-deficiency anemia?

A 15-year-old girl who has heavy menstrual periods

A client with cancer is diagnosed with typhitis. Which emergency intervention would the nurse perform?

Administer broad-spectrum antibiotics intravenously.

The toddler with a cancer diagnosis is seen for a well-child checkup. Which health maintenance activity will the nurse exclude?

Administering the measles, mumps, rubella (MMR) vaccine

A child is to receive radiation therapy this morning. The nurse would expect to see which type of drug prescribed to this child?

Antiemetic

The nurse is planning care for a school-aged child recovering from being hit by a motor vehicle while riding a bicycle. For what will the nurse assess to determine the onset of disseminated intravascular coagulation in this child?

Bleeding from intravenous sites

The nurse is admitting to an examination room a child with the diagnosis of "probable acute lymphoblastic leukemia." What will confirm this diagnosis?

Bone marrow aspiration

How can the nurse most simply describe for distressed parents a rhabdomyosarcoma that has been found in their 5-year-old?

Call it a tumor of muscle tissue

The nurse is preparing a discharge teaching plan for the parents of an 8-year-old girl with leukemia. Which instruction would be the priority?

Calling the doctor if the child gets a sore throat

Which mechanism is central to cancers in children?

Cellular growth

A nurse is providing care to a child with hemophilia who is experiencing muscle and joint involvement related to the bleeding. Which would the nurse include as an adjunctive measure to control bleeding?

Compression

The pediatric nurse examines the radiographs of a client that show that there are lesions on the bone. This finding is indicative of:

Ewing sarcoma.

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 VIII

In hemophilia A, the classic form, only females manifest a bleeding disorder.

False

The nurse is caring for a child with leukemia. Which nursing intervention would be the highest priority for this child?

Following guidelines for protective isolation

The nurse is caring for a 4-year-old boy following surgical removal of a stage I neuroblastoma. Which intervention is most appropriate for this child?

Giving medications as ordered via least invasive route

A preschooler who received chemotherapy in the pediatric oncology outpatient department 1 week ago now has a temperature of 101.5°F (38.6°C). Which is the most appropriate response by the nurse?

Have the parent bring the child to the pediatric oncology clinic as soon as possible.

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

His stools will appear black.

The child with thalassemia may be given which classification of medication to prevent one of the complications frequently seen with the treatment of this disorder?

Iron-chelating drugs

A 15-year-old boy has been diagnosed with an osteogenic sarcoma 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

A nurse is explaining the difference between benign and malignant neoplasms to a group of parents. Which is the best explanation?

Malignant cells have unlimited growth.

When providing care for a child immediately after a bone marrow aspiration, which nursing action is priority?

Monitor the site dressing and vital signs.

The nurse is assessing a 3-year-old boy whose mother reports that he is listless and has been having trouble swallowing. Which finding suggests the child may have a brain tumor?

Observation reveals nystagmus and head tilt

The nurse is completing the health history of a 6-month-old infant with retinoblastoma with the child's parents. Which symptom should the nurse expect that the parents have observed?

One pupil appears white.

A hospice nurse is providing at-home care to a child with end-stage cancer. The nurse is developing a plan of care to manage the child's pain. Which medications will the nurse likely include?

Opioids

A nurse is providing care to a toddler with nephroblastoma and is being evaluated. Which nursing action would be most important?

Placing a "no abdominal palpation" sign above the child's bed

What is the priority action the nurse should take when caring for a child newly diagnosed with Wilms tumor (nephroblastoma)?

Protect the abdomen from manipulation.

A child with ALL is receiving methotrexate for therapy. Which nursing diagnosis would best apply to him during therapy?

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

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?

Risk for infection

The nurse is teaching the parents of a 15-year-old boy who is being treated for acute myelogenous leukemia about the side effects of chemotherapy. For which symptoms should the parents seek medical care immediately?

Temperature of 101° F (38.3° C) or greater

The physician orders an alkylating agent for a child's chemotherapy. Which best describes an action produced by these types of agents?

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

The nurse is caring for a child admitted to the hospital for an open fracture of the femur following a motor vehicle accident. The nurse notes the following lab values: white blood cells 10,000mm3, hemoglobin 7.9 g/dL (79 g/L), hematocrit 28%, platelets 151,000 mm3. Which nursing action is priority?

Transfuse 1 unit of packed red blood cells

The school nurse is providing information to parents of adolescents about prevention of cervical cancer. Which information is included in the teaching?

Vaccine against human papilloma virus

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.

When planning care for a child with idiopathic thrombocytopenic purpura, the nurse plans to teach her:

not to pick or irritate her nose.

To prevent further sickle cell crisis, the nurse would advise the parents of a child with sickle cell anemia to:

notify a health care provider if the child develops an upper respiratory infection.

The nurse is assessing a child and notices pinpoint hemorrhages appearing on several different areas of the body. The hemorrhages do not blanch on pressure. The nurse documents this finding as:

petechiae.

An experienced nurse is orienting a new nurse to the oncology unit. Which action by the new nurse would require intervention?

pouring unused chemotherapy medicine into a sink drain

The nurse is administering meperidine as ordered for pain management for a 10-year-old boy in sickle cell crisis. The nurse would be alert for:

seizures.