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Parents ask why their child just diagnosed with leukemia needs a "spinal tap." Which is the best response by the nurse? "It will help rule out a second malignancy." "Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system." "The spinal tap will help relieve pressure and headache for your child." "A sample of cerebrospinal fluid is needed to check for possible central nervous system infection."
"Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system." Explanation: The cerebrospinal fluid is checked so the clinician can determine whether leukemic cells have invaded the central nervous system. It is common for a chemotherapy medication, usually methotrexate, to be administered immediately following lumbar puncture as treatment for potential infiltration.
Which risk factors will the nurse identify when screening infants for iron-deficiency anemia? Select all that apply. birth prior to 37 weeks' gestation recurrent constipation and colic frequent vomiting and regurgitation drinking 48 oz milk in a bottle daily maternal anemia during pregnancy
birth prior to 37 weeks' gestation frequent vomiting and regurgitation drinking 48 oz milk in a bottle daily maternal anemia during pregnancy Explanation: Risk factors for iron-deficiency anemia in infants include preterm birth and maternal anemia during pregnancy because infant iron stores are provided during the end of pregnancy. Infants who frequently vomit and consume large amounts of milk may not absorb iron adequately. Constipation and colic are not risk factors for iron-deficiency anemia.
The nurse is providing care to a child with disseminated intravascular coagulation and is preparing to administer heparin. The parent asks why the heparin is being given. Which response by the nurse would be most appropriate? "Heparin helps to reduce the consumption of platelets." "It helps to counteract the clotting cascader." "It reduces the risk for significant hemorrhage." "Heparin provides a stimulus for clotting factor production."
"Heparin helps to reduce the consumption of platelets." Explanation: Heparin reduces platelet consumption, thereby resulting in improved platelet counts. It does not counteract the clotting cascade. It is an anticoagulant and, as such, increases the risk for bleeding and hemorrhage. Heparin does not stimulate clotting factor production.
A nurse is providing teaching to the parents of a child diagnosed with sickle cell anemia. The discussion is focused on precipitating factors for sickle cell crisis. Which statement by the parents requires the nurse to reinforce the teaching? "I make sure my child wears a good warm coat and gloves during winter." "Our family is taking a fun hiking trip up in the mountains next week." "We always take water along when we are on an outing." "I make sure our child is up to date on all immunizations."
"Our family is taking a fun hiking trip up in the mountains next week." Explanation: High altitudes are a contributing factor for sickle cell crisis and should be avoided, as should flights in planes that are not pressurized. Extreme temperatures (hot or cold) are also triggers for a crisis so keeping warm during the winter is important. Dehydration and exposure to infection or other illness are precipitating factors for sickle cell crisis. Adequate hydration and keeping up with immunizations are imperative for health and wellness in a child diagnosed with sickle cell anemia.
A nurse is providing dietary interventions for a 5-year-old with an iron deficiency. Which response indicates a need for further teaching? "Red meat is a good option; he loves the hamburgers from the drive-thru." "He will enjoy tuna casserole and eggs." "There are many iron fortified cereals that he likes." "I must encourage a variety of iron-rich foods that he likes."
"Red meat is a good option; he loves the hamburgers from the drive-thru." Explanation: While iron from red meat is the easiest for the body to absorb, the nurse must limit fast food consumption from the drive-thru as it is also high in fat, fillers, and sodium. The other statements are correct.
The nurse is 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? Blurred vision Nausea and vomiting Sudden onset of knee pain Bleeding from intravenous sites
Bleeding from intravenous sites Explanation: Disseminated intravascular coagulation is an acquired disorder of blood clotting that results from excessive trauma. The child begins to develop petechiae or have uncontrolled bleeding from puncture sites from injections or intravenous therapy. Blurred vision, nausea, vomiting, and a sudden onset of knee pain are not manifestations associated with disseminated intravascular coagulation.
The nurse is admitting to an examination room a child with the diagnosis of "probable acute lymphoblastic leukemia (ALL)." What will confirm this diagnosis? Complete white blood count Lethargy, bruising, and pallor History of leukemia in twin Bone marrow aspiration
Bone marrow aspiration Explanation: Bone marrow aspiration and biopsy are diagnostic. An abnormal white blood count and symptoms of lethargy, bruising, and pallor only create suspicion of leukemia; a twin may or may not be affected.
A 5-year-old client has been diagnosed with leukemia and is currently on chemotherapy and radiation. The child is having difficulty due to mucositis. Which is the most appropriate nursing diagnosis for this child? Pain due to neoplastic process in bone Disturbed body image related to loss of hair after chemotherapy Compromised family coping related to long-term chemotherapy regimen Risk for imbalanced nutrition, less than body requirements, related to inflammation
Risk for imbalanced nutrition, less than body requirements, related to inflammation Explanation: Mucositis is inflammation of the oral mucosa, which puts this child at risk for risk for imbalanced nutrition. The client may have pain due to neoplastic process in the bone, but that is not mentioned in the scenario. The client may have lost hair, but that is not mentioned. The client's family coping is also not mentioned.
The nurse is assessing a school-aged child with sickle-cell anemia. Which assessment finding is consistent with this child's diagnosis? Slightly yellow sclera Enlarged mandibular growth Increased growth of long bones Depigmented areas on the abdomen
Slightly yellow sclera Explanation: In sickle-cell anemia, eye scleras become icteric or yellowed from the release of bilirubin from the destruction of the sickled cells. Mandibular and long bone growth and depigmentation are not manifestations of this health problem.
A 5-year-old child is at the pediatric clinic for a well-child visit. Which symptom alerts the health care provider that this child might have acute lymphoblastic leukemia (ALL)? joint pain and swelling anorexia and weight loss abdominal pain, nausea, and vomiting lethargy, bruises, and lymphadenopathy
lethargy, bruises, and lymphadenopathy Explanation: Although all of these symptoms could be related to leukemia, the most likely are lethargy, bruises, and lymphadenopathy. Joint pain and swelling could also be juvenile arthritis or another disorder. Anorexia and weight loss are fairly nonspecific, as is abdominal pain, nausea, and vomiting. With ALL, because the bone marrow overproduces lymphocytes and therefore is unable to continue normal production of other blood components, the first symptoms of ALL in children usually are those associated with decreased RBC production (anemia) such as pallor, low-grade fever, and lethargy. A low thrombocyte (platelet) count will lead to petechiae and bleeding from oral mucous membranes and cause easy bruising on arms and legs. As the spleen and liver begin to enlarge from infiltration of abnormal cells, abdominal pain, vomiting, and anorexia occur. As abnormal lymphocytes invade the bone periosteum, the child experiences bone and joint pain. Central nervous system (CNS) invasion leads to symptoms such as headache or unsteady gait. On physical assessment, painless, generalized swelling of lymph nodes is revealed.
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? painless, enlarged lymph node anorexia weight loss night sweats
painless, enlarged lymph node Explanation: 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.
The nurse develops a meal plan for a child with iron-deficiency anemia. Which meal would the nurse teach the parent has the highest amount of iron? red meat, eggs, oatmeal, and dried fruit chicken, corn, brown rice, and oranges pork, broccoli, white rice, and strawberries tuna salad with eggs, whole wheat crackers, and blueberries
red meat, eggs, oatmeal, and dried fruit Explanation: Iron-deficiency anemia occurs when the blood does not have enough iron to produce hemoglobin. The anemia can be corrected via iron supplementation, nutrition, and even blood transfusion if the anemia is severe. Foods that have the highest sources of iron include red meat, tuna, eggs, tofu, enriched grains, dried beans and peas, dried fruits, green leafy vegetables and iron-fortified breakfast cereals. The nurse should teach the meal containing red meat, eggs, oatmeal, and dried fruit has the highest amount of iron. Chicken has less iron than red meat, and corn has only a small amount. All the fruits listed have iron, but when dried, the iron levels increase. Pork has a limited amount of iron, and white rice contains almost no iron. Brown rice and whole grains contain higher iron amounts.
The nurse is examining the hands of a child with suspected iron deficiency anemia. Which finding should the nurse expect? capillary refill in less than 2 seconds pink palms and nail beds absence of bruising spooning of nails
spooning of nails Explanation: A convex shape of the fingernails termed 'spooning' can occur with iron deficiency anemia. Capillary refill in less than 2 seconds, pink palms and nail beds, and absence of bruising are normal findings.
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? bradycardia and distinct S1 and S2 sounds wheezing and diminished breath sounds respiratory distress and poor perfusion tachycardia and respiratory distress
tachycardia and respiratory distress Explanation: 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.
The nurse is teaching the parents of a 15-year-old boy who is being treated for acute myeloid leukemia about the side effects of chemotherapy. For which symptoms should the parents seek medical care immediately? earache, stiff neck, or sore throat blisters, ulcers, or a rash appear temperature of 101°F (38.3°C) or greater difficulty or pain when swallowing
temperature of 101°F (38.3°C) or greater Explanation: The parents should seek medical care immediately if the child has a temperature of 101°F (38.3° C) or greater. This is because many chemotherapeutic drugs cause bone marrow suppression; the parents must be directed to take action at the first sign of infection in order to prevent overwhelming sepsis. The appearance of earache, stiff neck, sore throat, blisters, ulcers, or rashes (or difficulty/pain when swallowing) are reasons to seek medical care, but are not as grave as the risk of infection.
The nurse is caring for a toddler taking ferrous sulfate for severe iron-deficiency anemia. Which report by the parent is most concerning? "I brush my child's teeth once every day." "My child's stools are darker than usual." "I mix ferrous sulfate with milk in a bottle." "My child takes ferrous sulfate after meals."
"I mix ferrous sulfate with milk in a bottle." Explanation: Ferrous sulfate may not be absorbed if taken with milk or tea, and if the parent mixes the medicine with milk in a bottle, there is also concern that if the child does not drink the entire amount of medication. Ferrous sulfate may be taken after meals to prevent gastrointestinal irritation. Dark stools are a common side effect of ferrous sulfate. Parents should be encouraged to brush the child's teeth thoroughly to prevent teeth staining.
A 9-month-old infant with iron-deficiency anemia is given ferrous sulfate therapy. Which assessment would best help the nurse determine that the infant is actually taking it daily? The reticulocyte count will have decreased. The infant will develop diarrhea. The stools will appear black. The infant will be more irritable than at the last visit.
The stools will appear black. Explanation: Oral iron supplements are dark in color because the iron is pigmented. As a result of digestion of this pigment, the stools of an infant taking iron will be dark to black. Taking iron supplements will cause constipation, not diarrhea. After treatment with iron, the reticulocyte count should be increased, not decreased. Children with iron deficiency are tired and many times irritable. With correction of the deficiency, the infant should be less irritable and have more energy.
The nurse is caring for a child with leukemia. Which nursing intervention would be the highest priority for this child? encouraging the child to share feelings grouping nursing care following guidelines for reverse isolation providing age-appropriate activities
following guidelines for reverse isolation Explanation: The child with leukemia is susceptible to infection, especially during chemotherapy. Infections such as meningitis, septicemia, and pneumonia are the most common causes of death. To protect the child from infectious organisms, follow standard guidelines for reverse isolation. Grouping nursing care to provide rest is important, but not the highest priority. Encouraging the child to share feelings and providing age-appropriate activities are important, but psychological issues are a lower priority than physical.
Children with acute lymphoblastic leukemia (ALL) may need periodic lumbar punctures. The nurse would teach the parent that this is done to assess for: platelets. leukemic cells. early meningitis. early development of septicemia.
leukemic cells. Explanation: Acute lymphoblastic leukemia (ALL) is a rapidly progressive cancer affecting the undifferentiated or immature cells. It is the most common form of cancer in children. Throughout the course of the disease and treatment the child will be tested regularly for complete blood counts, bone marrow aspirations, lumbar punctures, and testing for renal and liver function. Lumbar punctures are performed to determine if leukemic cells have infiltrated the central nervous system. The white blood cells, temperature, and other symptoms would be indicative of meningitis and septicemia. The platelet count would be assessed for the possibility of bleeding.
The nurse is caring for a child with aplastic anemia. The nurse is reviewing the child's blood work and notes the granulocyte count is about 500, platelet count is over 20,000, and the reticulocyte count is over 1%. The parents ask if these values have any significance. Which response by the nurse is appropriate? "The doctor will discuss these findings with you when he comes to the hospital." "These values will help us monitor the disease." "These labs are just common labs for children with this disease." "I'm really not allowed to discuss these findings with you."
"These values will help us monitor the disease." Explanation: This response answers the parent's questions. In the nonsevere form, the granulocyte count remains about 500, the platelets are over 20,000, and the reticulocyte count is over 1%. The other responses do not address what the parents are asking and would block therapeutic communication.
A 9-year-old child with leukemia is scheduled to undergo an allogeneic 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." "The risk for rejection is much less with this type of transplant." "You won't need to receive the high doses of chemotherapy before the transplant." "You'll need to have an incision in your hip area to instill the cells."
"We'll need to have a match to a donor." Explanation: An allogeneic hematopoietic stem cell transplantation (HSCT) refers to transplantation using stem cells from another individual that are harvested from the bone marrow, peripheral blood, or umbilical cord blood. With this type of transplant, human leukocyte antibody (HLA) matching must occur. Therefore, the lesser the degree of HLA matching in the donor, the higher the risk for graft rejection and graft-versus-host disease (GVHD). Regardless of the type of transplant, a period of purging of abnormal cells in the child is necessary and accomplished through high-dose chemotherapy or irradiation. The procedure is accomplished by intravenously infusing hematopoietic stem cells into the child.
The nurse is explaining the procedure of bone marrow aspiration to a 6-year-old child with leukemia. What explanation would be best to give to the child? "You will need to lie still afterward to prevent a headache." "You may feel pressure on your hip during the procedure." "You will have to lie on your back and hold your breath." "The numbing medicine on your skin will keep you from having pain."
"You may feel pressure on your hip during the procedure." Explanation: The bone marrow aspiration is performed on the iliac crest if the child is older and on the femur if the child is an infant. Bone marrow aspiration requires hard pressure to allow the needle to puncture the bone. A lidocaine/prilocaine cream is applied to the skin anywhere from 1 to 3 hours prior to the procedure to help numb the site where the needle will be inserted. Bone marrow aspirations and biopsies are usually performed with conscious sedation. If the child is an infant or there are special circumstances the procedure may be performed under anesthesia. The child is placed on the side for the procedure so the health care provider has better access to the iliac crest. The child will need to rest after the procedure to prevent bleeding, but is not required to lay flat on the back. Children who have had a lumbar puncture may need to lie on the back and are at risk for a headache.
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 Impaired skin integrity Deficient fluid volume Risk for delayed growth and development
Risk for infection Explanation: 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.
The nurse will select which meal as the best choice for a child with iron-deficiency anemia? cheeseburger, broccoli, and fresh strawberries chicken breast, French fries, and sweetened tea peanut butter sandwich, cheese stick, and applesauce two slices of pepperoni pizza and a glass of skim milk
cheeseburger, broccoli, and fresh strawberries Explanation: 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 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: destroy any remaining cancer cells. kill enough cancerous cells to induce remission. destroy any residual cancer cells. follow up for recurrent disease or late effects.
kill enough cancerous cells to induce remission. Explanation: 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.
