Pediatric Hematological immunological and neoplastic disorders

36. Typical signs of a child with iron deficiency anemia include all of the following except: 1. Tachycardia. 2. Bradycardia. 3. Thinning of hair. 4. Shortness of breath.

ANS: 2 Feedback 1. The lack of red blood cells does not allow for enough oxygen carrying capacity. 2. Tachycardia is a sign, not bradycardia. 3. Thinning hair is a common sign of long-term iron deficiency anemia in children. 4. Shortness of breath is present because of the lack of oxygen carrying capacity of the red blood cells when the hemoglobin is low.

The nurse is providing patient teaching for a school-age patient and parents. Chemotherapy is prescribed for cancer treatment. Before the first dose is administered on an outpatient basis, which teaching is most important for the nurse to provide? 1. Prompt recognition of adverse effects after the therapy. 2. Explain how to immediately initiate protective precautions. 3. Promote nutrition with the preparation of favorite foods. 4. Have icy drinks available to improve oral fluid intake.

ANS 1 1 This is correct. It is most important for the patient and family to recognize adverse effects to the chemotherapy and seek medical assistance as directed. 2 This is incorrect. Protective precautions are explained only as needed. 3 This is incorrect. Promoting the preparation of the patient's favorite food may or may not be necessary. Some favorite foods can be available after the first treatment if needed or desired. 4 This is incorrect. During chemotherapy, patients may experience mouth sores and have difficulty eating and drinking. Some patients like cold liquids, and others prefer warm liquids. It is unlikely that this is an issue after the first chemotherapy treatment.

42. Parents of a 5-year-old with Sickle Cell disease are asking about care during their childs painful episodes. The nurse knows that the pain of Sickle Cell disease is caused by: 1. The lack of iron in the body. 2. The hypoxia that happens to the tissue, causing ischemia. 3. The red blood cell destruction. 4. A buildup of oxygen in the body

ANS: 2 Feedback 1. The lack of oxygen is the causative agent for pain. 2. The ischemia causes the painful episodes. 3. Red blood cells are malformation with this disease, not destroyed. 4. The transport of oxygen to the tissue causes the painful episodes.

43. A child has been admitted with acute Sickle Cell crisis. During the assessment, the nurse would expect to see all of the following except: 1. Swollen joints. 2. Jaundice in the eyes. 3. An enlarged liver. 4. Severe pain in the abdomen.

ANS: 3 Feedback 1. Swollen joints occur because of the ischemia and inflammatory response. 2. Jaundice occurs because of the lack of blood flow to the liver. 3. The liver does not enlarge. 4. Severe abdominal pain occurs because of the lack of oxygen carried to the tissue.

49. A mother has reported that her 18 month old has a lump on the abdominal area. She has noticed the lump while changing her daughters diaper. A nurse should assess by using which measure(s)? 1. An abdominal circumference 2. Palpation and an abdominal circumference 3. Assessing the childs pain when the area is palpated 4. Assessing pain, palpation, and an abdominal circumference

ANS: 4 Feedback 1. Palpation and pain assessment should also be conducted for a thorough exam. 2. A pain assessment is needed for the child. 3. An abdominal circumference should be performed. 4. Assessing pain, palpating, and measuring the abdominal circumference will aid in the nursing process for the child.

59. A child with a known diagnosis of HIV should not receive immunizations against common childhood illnesses. True or False

False The child should receive immunization on schedule to prevent further complications of the illness.

3. Acquired thrombocytopenia involves antibodies against: 1. Platelets. 2. Basophils. 3. Neutrophils. 4. Eosinophils.

ANS: 1 Feedback 1. Decreased platelet production, increased platelet destruction, or splenic sequestration is common with thrombocytopenia. 2. The basophils are intact with thrombocytopenia. 3. The neutrophils function with thrombocytopenia. 4. The eosinophils are intact with thrombocytopenia.

The nurse is counseling a couple with a 3-year-old toddler diagnosed with hemophilia after experiencing excessive bleeding after a minor injury from a fall. Which teaching is most important for the nurse to provide to the parents? 1. Stressing the need for preventing injury in the environment with supervision, helmet use, and activity restrictions 2. Sharing the availability of resources from the National Hemophilia Foundation publications 3. Preparing them for the possibility of altered family dynamics and how illness may impact financial resources 4. Explaining the importance of allowing the toddler to grow up as normally as possible

ANS 1 1 This is correct. Preventing injury in the environment with supervision, helmet use, and activity restrictions is the most important teaching for the nurse to provide to the family. The toddler will be especially challenging because of normal development, which places the toddler at a high risk for injury. 2 This is incorrect. Sharing the availability of resources from the National Hemophilia Foundation publications is important; however, another topic of teaching is more important. 3 This is incorrect. Helping the parents prepare for the possibility of altered family dynamics and how the illness may impact financial resources is important; however, the prevention of injury is most important. 4 This is incorrect. It is important for the nurse to teach the parents about allowing the toddler to grow up as normally as possible, but the nature of hemophilia will grossly alter the toddler's future activities, such as the avoidance of contact sports. There is another topic of more importance.

The nurse is providing care for a 4-year-old child diagnosed with non-Hodgkin's lymphoma. The nurse is aware that multiple blood samples are ordered, and the child is scheduled for a lumbar puncture with bone marrow aspiration. Which intervention will the nurse plan to prepare the patient for the testing? 1. Use simple terms and provide a needless syringe for treatment on a stuffed animal. 2. Provide information to the child's parents and encourage them to explain procedures. 3. Withhold details from the patient until right before testing procedures are performed. 4. Expect that a 4-year-old patient is incapable of understanding or cooperating during procedures.

ANS 1 1 This is correct. The nurse needs to allow for medical play when age appropriate; a needleless syringe for stuffed animal treatment is a good choice for a 4-year-old child. 2 This is incorrect. The nurse will explain procedures to the patient's parents; however, it is the nurse's responsibility to provide teaching to the patient and ask for parenteral support. 3 This is incorrect. Even at the age of 4 years, the patient is much more likely to be cooperative with some preparation prior to the testing. 4 This is incorrect. The nurse can teach the patient on an age-appropriate level and elicit more cooperation than without teaching and preparation.

4. A definitive diagnosis for leukemia is based on results of: 1. Fatigue and pallor. 2. A urinalysis. 3. A bone marrow aspirate. 4. A history and a physical.

ANS: 3 Feedback 1. Fatigue and pallor are presumptive signs of leukemia. 2. A urinalysis does not give indications as to a diagnosis for leukemia. 3. The abnormal cells of leukemia are found in the bone marrow. 4. A history and a physical will help identify signs and symptoms, but not give a definitive diagnosis.

21. The child states, I hate losing my hair during chemotherapy. Which of the following interventions is important to the care of the child? 1. A wig similar to the usual hair style can be purchased. 2. Playing with others should include cancer survivors with hair loss. 3. Discuss the benefits of therapy with the child and caregivers. 4. Discuss feelings of the change and concerns with the child.

ANS: 4 Feedback 1. Attempting to cover the head with a wig needs to be discussed with the child before attempting to purchase it. 2. The child should be playing with children that he/she feels most comfortable with. This does not address the concerns of the patient at this time. 3. This does not address the childs concerns and needs to focus on the body image issue at this time. 4. The child needs an opportunity to discuss feelings about the changes in body image.

A pediatric patient has acute myelocytic leukemia, and patient and family are considering treatment options aimed at long-term success. Which contemplated treatment involves using the patient's stem cells collected before radiation of cancerous bone marrow? Select all that apply. 1. Allogenic 2. Autologous 3. Peripheral blood stem cells (PBSC) 4. Umbilical cord stem cells 5. Platelet transfusion

ANS 2,3 1. This is incorrect. Allogenic transplantation comes from another person rather than from the patient. 2. This is correct. Autologous cells are the cells that were drawn from the patient. 3. This is correct. Peripheral blood stem cells can be drawn from the patient and are therefore autologous. 4. This is incorrect. Umbilical cord stem cells come from a newborn infant and not the patient. 5. This is incorrect. Stem cells are those initial (parent) cells from which other blood cells are grown. Platelets are one of the products of cell formation.

5. When caring for a child with Wilms tumor, which of the following nursing interventions would be most important? 1. Place child on neutropenic precautions. 2. Monitor bowel sounds in order to detect ileus. 3. Position in the high fowlers position in order to increase lung capacity. 4. Avoid palpation of the abdomen.

ANS: 4 Feedback 1. The child will need neutropenic precautions if radiation or chemotherapy are provided. 2. A Wilms tumor should not cause an ileus. 3. The lungs are not affected in a child with a Wilms tumor, so it is not the most important intervention at this time. 4. The tumor is located in the abdomen and may be harmful to the child with palpation of the abdomen.

26. A school-age child is admitted with vaso-occlusive Sickle Cell crisis. The childs care should include which of the following? 1. Hydration and pain management 2. Oxygenation and factor VIII replacement 3. Electrolyte replacement and the administration of heparin 4. Correction of alkalosis and reduction of energy expenditure

ANS: 1 Feedback 1. Hydration and pain medication are needed in order for the child to heal. 2. Oxygenation is needed, but factor VIII is not used in Sickle Cell treatment. 3. Hydration is important, but the use of heparin will not decrease the pain. 4. The child needs a balanced electrolyte state and can be as active as possible without pain.

An adolescent 16 years of age and the parents and health-care team agree that the patient is to undergo HSCT. Which specific nursing interventions will be included for the care of this patient? Select all that apply. 1. Sterility of the central line must be maintained. 2. High-dose chemotherapy and/or total body irradiation is administered. 3. IV for the administration of stem cells is established and maintained. 4. Fluid loss from urine, vomiting, and/or diarrhea is closely monitored. 5. Anti-T-cell immunotoxins are administered immediately after the transfusion.

ANS 1,2,3 1. This is correct. Strict asepsis with central venous catheter care is a critical intervention that all health-care providers must follow. 2. This is correct. Chemotherapy will treat the diagnosed cancer and will also reduce the immune response. The reduction of immune responses will aid in acceptance of the transplanted stem cells. 3. This is correct. It is important to carefully initiate, monitor, and maintain the IV transfusion of the stem cells harvested from bone marrow, peripheral blood, or the umbilical vein of the placenta. 4. This is incorrect. Monitoring both intake and output will provide information about kidney function and fluid balance. Vomiting and diarrhea is not expected during HSCT; however, signs and symptoms of chronic GVHD occur about 100 days after transplant and affect the liver, gastrointestinal system, oral mucosa, and lungs. 5. This is incorrect. High-level nutritional intake must be provided to encourage healing and the body's acceptance of the transplanted cells.

The nurse case manager is providing care and support to a mother with AIDS who has an infant who also tests positive for the condition. Which statement by the mother indicates to the nurse that additional teaching is needed? Select all that apply. 1. "I wish I could control the baby's pain without so much medication." 2. "I am so looking forward to the time when the baby is no longer infectious." 3. "I absolutely do not want the day-care staff to know about the baby's condition." 4. "If I am to become a better mother, I need to work on my self-esteem and self-value." 5. "I keep hoping every day that a cure for my baby and me can be found."

ANS 1,2,3 1. This is correct. The nurse needs to teach pain management techniques and reinforce that tolerance to opioids may require increased dosing. The nurse also needs to teach and encourage use of nonpharmacological pain interventions. 2. This is correct. When the mother expresses the expectation that the infant will eventually be noninfectious, additional teaching by the nurse is needed. 3. This is correct. When the mother expresses opposition to the day-care staff knowing about the infant's condition, additional teaching is needed. The nurse needs to support the mother with making complex day-care arrangements. The nurse also has a responsibility to educate day-care and school staff on current AIDS information. 4. This is incorrect. The nurse needs to encourage positive self-concept and suggestions of how to avoid the HIV-related stigma. The nurse needs to provide support but not necessarily teaching. 5. This is incorrect. The hope expressed by the mother for a cure for herself and her infant does not require additional teaching by the nurse.

During the treatment of a preschool child for anemia, laboratory tests reveal the child is also positive for lead poisoning. The child is currently living in an older home being renovated by the parents. Which teaching does the nurse provide to the parents? Select all that apply. 1. The possibility of removing the child from the environment 2. Methods to remove paint chips or dust from the environment 3. Details about behavior changes indicating additional exposure 4. Recommendation of foods that will decrease absorption of lead 5. The need for a child development specialist to evaluate the child

ANS 1,2,5 1. This is correct. It is very important that the child diagnosed or being treated for lead poisoning be removed from the contaminated environment. 2. This is correct. It is very important that the parents know how to remove lead from the environment. The recommended method is to remove paint chips or dust with a damp paper towel and discard it in the trash. Use another wet paper towel to clean the surface and discard the paper towel. 3. This is incorrect. Central nervous system signs of lead poisoning include hyperactivity, impulsiveness, lethargy, irritability, loss of developmental progress, hearing impairment, and learning difficulties. However, the goal is to avoid exposure. 4. This is incorrect. Iron-deficiency anemia causes a greater level of lead absorption, but correcting the anemia does not prevent the child in the event of additional exposure. 5. This is correct. Because of the impact of lead poisoning on the development of the child, the parents need to know the importance of having a child development specialist evaluate the child as needed.

The nurse is providing care to two children on a pediatric unit. One child is diagnosed with iron-deficiency anemia, and the other has sickle cell disease. Which manifestation does the nurse recognize as being different between the two children? 1. A child with iron deficiency expresses significant pain and discomfort. 2. A child with sickle cell disease experiences varying amounts of joint pain. 3. A child with iron-deficiency anemia experiences normal physical growth. 4. Sickle cell disease is transmitted as a dominant trait from one parent.

ANS 2 1 This is incorrect. A child with iron-deficiency anemia may experience irritability, anorexia, tachycardia, systolic murmur, brittle and concave nails, and poor muscle tone, and may be prone to infection. Significant pain and discomfort is not expected. 2 This is correct. Vaso-occlusive crisis (obstruction of blood flow causing tissue hypoxia and necrosis) is a painful episode with hand-foot syndrome (dactylitis), causing symmetrical infarct in the bones of the hands and feet along with very painful swelling of soft tissue. 3 This is incorrect. A child with either iron-deficiency anemia or sickle cell disease may experience delayed growth and development. 4 This is incorrect. When both parents have the recessive sickle cell trait, there is a 1 in 4 chance with each pregnancy that the child will have sickle cell disease (SCD). About 1 in 13 African American babies are born with this sickle cell trait.

The nurse in a pediatric oncology unit understands that painful tests and treatments are common for children with cancer. Which interventions does the nurse decide to use to help manage pain for a 6-year-old patient scheduled for diagnostic testing? 1. Avoid too many details that may scare the child. 2. Use language that is age appropriate for the child. 3. Promise the child a toy for cooperating and not crying. 4. Explain why the test is performed without pain medication.

ANS 2 1 This is incorrect. Consider the developmental level of the child and use words he or she can understand. 2 This is correct. State what the child will hear, see, feel, touch, and smell. The unknown is more frightening to a child than experiencing expected happenings, equipment, and procedures. 3 This is incorrect. Provide a special box of toys to have a treat to look forward to after the procedure. Tell the child that it is okay to cry. 4 This is incorrect. Anesthesia may put the child to sleep with a mask or IV medication. Administer medication for any pain, including headache, as needed.

The nurse is preparing teaching materials for parents with children diagnosed with anemia. Which information will be marked as being specifically for the child diagnosed with sickle cell anemia? 1. Follow a balanced nutritious diet. 2. Encourage drinking as much fluids as possible. 3. Allow low-energy activities and rest periods. 4. Make sure that immunizations are up to date.

ANS 2 1 This is incorrect. The nurse recommends a balanced nutritious diet for all children, especially those with anemias. 2 This is correct. The child with sickle cell anemia is encouraged to drink as much fluid as possible to help avoid the clumping of sickled cells. Hydration can be accomplished with IV therapy and oral fluids. Children with iron-deficiency anemia need a normal daily fluid intake. 3 This is incorrect. Anemias can cause fatigue; children should participate in low-level activities, as able. Caretakers will need to provide for adequate rest periods. 4 This is incorrect. Anemias put children at risk for infections; immunizations need to be up to date. Influenza and pneumonia vaccines are strongly recommended.

9. What is the most common opportunistic infection in children with the Human Immunodeficiency Virus? 1. Pneumocystic pneumonia 2. CMV 3. Meningitis 4. Encephalitis

ANS: 1 Feedback 1. Pneumocystic pneumonia is most common, and children are treated prophylactically. 2. CMV is not considered an opportunistic infection. 3. Meningitis is not common in children with HIV. 4. Encephalitis can occur, but it is not a cause of infection.

A 19-year-old college student is being treated for non-metastatic Hodgkin's lymphoma with chemotherapy. Which recommendation by the nurse was made prior to beginning chemotherapy in order to promote a level of health? 1. Gain weight before treatment to offset weight loss. 2. Consider sperm banking because of expected sterilization. 3. Move in with parents to initiate quarantine protocols. 4. Withdraw from all college courses because of fatigue.

ANS 2 1 This is incorrect. The patient is likely to be experiencing weight loss from anorexia triggered by the disease process. Weight gain is unlikely; other nutrition recommendations are needed. 2 This is correct. Treatment with chemotherapy is likely to cause sterilization; the nurse needs to recommend sperm banking. Patients may not be able to think about a future and children; the nurse will explain the importance of having sperm at a future time. 3 This is incorrect. If the patient is living independently, there is no need to move in with parents unless care assistance is needed. The patient can initiate quarantine measures if necessary, which may be easier in an independent environment. However, other care needs may be met if living with caregivers. 4 This is incorrect. It is likely the patient will experience fatigue from chemotherapy. However, the patient may benefit from activities focused on something other than the illness and treatment. The patient may want to consider one class a term and the availability of computerized classes.

A toddler who is 2 years of age is cared for by a grandmother because of the death of the toddler's mother from AIDS. A critical nursing intervention is for the nurse to provide home-care instructions. Which points should the nurse emphasize? Select all that apply. 1. Hand hygiene precautions during hospitalization 2. Importance of keeping up to date with all childhood immunizations 3. Proper nutrition for a toddler diagnosed with the disease 4. Monitoring playmates in order to avoid childhood viruses 5. Prevention of bacterial infections as the treatment focus

ANS 2,3,4 1. This is incorrect. The nurse will emphasize the importance of following standard precautions, such as hand hygiene, at all times when providing care. 2. This is correct. Immunization against common childhood illnesses is required if the toddler is exposed to HIV/AIDS or tests positive for either condition. 3. This is correct. Nutritional management with high-calorie, nutrient-dense foods is critical to putting the infant's immune system in the best possible state to fight off infections. 4. This is correct. Prevention and management of opportunistic infections (OPs) is essential for children with severe immune suppressions. Playmates will be excluded from contact with the toddler if the playmates are sick. 5. This is incorrect. Administration of highly active antiretroviral therapy drug (HAART) combination therapy (a strategy analogous to the treatment of infectious diseases) has improved efficacy, minimized toxicity, and delayed drug resistance. The treatment of the toddler is not just focused on bacterial infections.

The nurse is providing care for an adolescent female who just gave birth to a neonate. The mother tests positive for HIV; however, the mother did not receive prenatal care. Based on the nurse's understanding about HIV/AIDS, which interventions does the nurse expect? Select all that apply. 1. Placement of the neonate in foster care because of deficient parenteral care 2. Performance of HIV polymerase chain reaction (PCR) test on the neonate 3. Recommended virological diagnostic testing for the neonate 4. Immediate immunization of the neonate against common childhood illnesses 5. Nutritional management that includes high-calorie, nutrient-dense foods

ANS 2,3,5 1. This is incorrect. Neonates born to HIV-positive mothers are not routinely placed in foster care. The scenario does not present enough information to determine deficient parenteral care of the neonate. 2. This is correct. HIV polymerase chain reaction (PCR) is used for detection in infants born to HIV-infected mothers because of the presence of maternal antibodies transferred transplacentally; preferred virological assays include HIV DNA PCR and HIV RNA assays. 3. This is correct. Virological diagnostic testing is recommended at birth in infants at high risk for HIV infection (e.g., infants born to HIV-infected mothers who did not receive prenatal care or prenatal antiretroviral therapy). 4. This is incorrect. Immediate immunization is not recommended; however, immunization against common childhood illnesses is strongly recommended if exposed to HIV. The immunizations will be given when age appropriate. 5. This is correct. The nurse will expect initiation of nutritional management that includes high-calorie, nutrient-dense foods.

A 12-year-old patient is experiencing pain in the abdomen after receiving chemotherapy. When developing a care plan, for which interventions will the nurse plan for pain management? 1. Application of heating pads to the abdomen 2. Application of cold packs to the chest area 3. Alternative therapy such as aromatherapy 4. Medication for alleviation of abdominal pain

ANS 3 1 This is incorrect. Applying heating pads will increase circulation to the area and increase pain. 2 This is incorrect. Cold packs to the abdomen may resolve abdominal issues but will not be effective if applied to the chest. 3 This is correct. Aromatherapy is the therapeutic use of essential oils from plants (flowers, herbs, or trees) for the improvement of physical, emotional, and spiritual well-being. 4 This is incorrect. Antacids neutralize acids, which are not the direct cause of the patient's abdominal pain.

A 5-month-old infant is brought to the pediatrician's office, and the nurse is collecting information from the mother. The mother reports the infant is irritable, eats poorly, and is less active. The nurse identifies tachycardia and a systolic murmur. Which comment by the mother helps the nurse identify the infant's condition? 1. "I am pleased that he sleeps well at night." 2. "Up until recently he was a happy baby." 3. "Formula made him gassy and constipated." 4. "He has not been what I call really sick."

ANS 3 1 This is incorrect. The nurse does not identify any cause of the infant's condition from a comment about the infant sleeping well at night. 2 This is incorrect. The mother is confirming a change in the infant's behavior from a happy infant to one that is irritable. 3 This is correct. The infant is exhibiting manifestations related to iron deficiency anemia. The mother's comment is expressing a negative reaction to formula at 4 months of age. The nurse now needs to identify what the infant is being fed; cow's milk is an option but should not be introduced until 12 months old. This change can cause iron deficiency anemia. 4 This is incorrect. The mother's comment about the infant not being identifiably sick does not help the nurse identify the infant's condition.

28. What is the bacteria that most commonly results in respiratory tract infections in patients receiving chemotherapy? 1. Klebsiella 2. E. coli 3. Epstein Barre Virus 4. Proteus

ANS: 1 Feedback 1. Klebsiella is the most common bacteria found in respiratory infections in patients receiving chemotherapy. 2. E. coli is commonly found in GI infections, not respiratory infections. 3. The Epstein Barre Virus is found in neurological tract infections, not respiratory infections. 4. Proteus are not commonly found in patients with respiratory infections that are undergoing chemotherapy.

An 8-year-old child arrives at the emergency department with abdominal pain and fever. The child has a medical history of leukemia in remission. The nurse receives medical orders for the child. Which order does the nurse recognize as the priority? 1. Draw blood work for a CBC and blood culture. 2. Complete a thorough physical assessment. 3. Set up neutropenic precautions for the child. 4. Prepare the child to be transported to radiology.

ANS 3 1 This is incorrect. The nurse will avoid invasive procedures and use aseptic technique to draw from central lines if present. Laboratory outcomes are important, but this action is not the priority. 2 This is incorrect. The nurse will complete a thorough physical assessment. Vital signs, duration of current symptoms, and systems evaluations are of special interest. This information is important and will guide the physician for additional orders; however, this action is not the priority. 3 This is correct. Patients with a history of leukemia need to be triaged quickly and placed in a treatment room as soon as possible. Neutropenic precautions (protective isolation) need to be initiated. The cancer cells, along with the cancer treatments, place a burden on the child's immune system. The disease pathophysiology makes observation and prevention of infection a priority. 4 This is incorrect. Radiological studies may be in order after the initial assessments and antibiotics have begun. The administration of antibiotics within 60 minutes of assessment for the presence of fever is of greater importance.

The parents of a 4-year-old toddler bring the child to the pediatrician because a lump is found in the toddler's waist area. Diagnostic testing verifies the toddler has a Wilms' tumor on the right kidney. The toddler is to be sent home until scheduled surgery. Which teaching is essential for the parents regarding preoperative care? 1. Promote hydration by increasing fluid intake. 2. Maintain a side position with pillows for sleeping. 3. Avoid palpating the tumor and pushing or lifting in the area. 4. Provide information about postoperative care.

ANS 3 1 This is incorrect. The parents need to provide the toddler with a balanced and healthy diet. There is no reason to expect dehydration or to increase fluids. 2 This is incorrect. There is no identifiable benefit to keeping the toddler in a side-lying position with pillow placement during sleep; keeping a 4-year-old toddler in one position may be challenging. 3 This is correct. Do not palpate the tumor, because this can cause the proliferation or spread of cancer cells. Avoid pushing or lifting in tumor area when handling and bathing the child. This is essential teaching before surgery. 4 This is incorrect. The nurse will provide information about the toddler's postoperative care; however, this is not the essential teaching before surgery.

A 9-year-old child is being treated for a brain tumor. The patient asks the nurse why there is pain in his head. Which reply by the nurse includes pathophysiology and age-appropriate communication? 1. Explain there is a blockage of blood flow to the brain. 2. State the cancer puts pressure on the neck and causes nerve pain. 3. Explain the growing brain tumor presses on some nerves in the head. 4. State the medications being given are causing the headache.

ANS 3 1 This is incorrect. Vaso-occlusive crisis (obstruction of blood flow causing tissue hypoxia and necrosis) is a painful episode with hand-foot syndrome (dactylitis), causing symmetrical infarct in the bones of the hands and feet along with very painful swelling of soft tissue in sickle cell crisis. 2 This is incorrect. A hematoma will cause pain, but there is no information in the scenario confirming the presence of a hematoma. The patient is experiencing pain in the head, not the neck. 3 This is correct. The patient is experiencing pain from a neoplasm in the brain directly affecting nerve receptors. The nurse's answer is pathologically correct and age appropriate. 4 This is incorrect. The medications are not a likely the cause of the patient's headache. Medication therapy is aimed at decreasing the size of the tumor and pain.

The nurse in a pediatric clinic is assessing an infant who is 6 months of age. The infant is pale with poor muscle tone. Auscultation reveals tachycardia; in addition, the infant is at the 35th percentile for both height and weight. The physician orders laboratory testing. Which laboratory value does the nurse expect? 1. Erythropoietin level of 1.9 mIU 2. Serum iron 24 mcg/dL 3. Normal RBC index in CBC 4. RBCs small in size and pale

ANS 4 1 This is incorrect. Erythropoietin level of 1.9 mIU is within normal limits. 2 This is incorrect. Serum iron 24 mcg/dL is within normal limits. 3 This is incorrect. CBC indicating a normal RBC index is not a sign of iron deficiency anemia. 4 This is correct. When an infant is diagnosed with iron deficiency anemia, the RBCs will appear small and pale in color.

A 16-year-old adolescent is diagnosed with osteosarcoma and has evidence of metastasis. The nurse calculates the absolute neutrophil count (ANC) daily. The patient asks the nurse to explain the ANC. Which information does the nurse provide? 1. The ANC is a measure of how well treatment is being tolerated by the body. 2. The ANC is total percentage of eosinophils plus the total percentage of basophils divided by the RBC. 3. The ANC provides a daily count of the number of antibodies in the circulating blood. 4. ANC measures of three types of white blood cells. A lower ANC indicates vulnerability to infection.

ANS 4 1 This is incorrect. The ANC does not specifically measure how the body is tolerating treatment. When the ANC is less than 500, the client is at high risk for infection. 2 This is incorrect. The ANC is a measure of bands, segmented cells, and white blood cells, which does not include eosinophils. 3 This is incorrect. Antibodies are not factored into the ANC. 4 This is correct. Calculating the ANC requires three numbers from the CBC and differential. The following formula calculates the ANC: (% bands + % segmented cells) x number of WBC x 10 = ANC. The result indicates the patient's vulnerability to infection and directs the level of isolation required.

11. Evidence of iron deficiency anemia in infants 9 to 12 months of age is most likely to be caused by: 1. Excessive milk intake. 2. Addition of solid foods. 3. Prematurity of the infant. 4. Rh and ABO incompatibility.

ANS: 1 Feedback 1. Excessive milk intake will decrease appetite and result in fewer intakes of foods containing iron. 2. Solid foods will contain iron, thus not causing a deficiency. 3. A premature infant may be anemic for other reasons besides iron deficiency. 4. The incompatibilities would have been noticed earlier in the infants life. This does not cause iron deficiency.

7. What factor contributes to a vaso-occlusive crisis in a child with Sickle Cell anemia? 1. Dehydration 2. Alkalosis 3. Infection 4. Stress

ANS: 1 Feedback 1. Fluid replacement with IV fluids increases the flow of blood, which decreases tissue hypoxia and the potential for dactylitis. 2. The child may become alkalotic, but this s not the contributing factor to the vaso-occlusive crisis. 3. Infections can cause dehydration, but this is not the leading cause of the vaso-occlusive crisis. 4. Stress is a manageable condition and does not lead to a vas-occlusive crisis.

56. A child with a known neuroblastoma begins vomiting uncontrollably. The nurse assesses the childs _____ for signs of increased intracranial pressure. 1. Pupils and hand grasps 2. Intake and output 3. Respiratory rate 4. Verbal responses

ANS: 1 Feedback 1. Sluggish and dilated pupils along with weakened hand grasps are an indication of increased ICP. 2. Intake and output are not a concern at this time. 3. The childs respiratory rate should be assessed, but it is not the priority at this time. 4. Verbal responses can be assessed, but it is not the priority at this time.

10. Which of the following diagnostic tests confirms Hodgkins disease? 1. Reed-Sternberg cells in the lymph nodes 2. Lymphocytes in the bone marrow 3. Neutrophils in the blood 4. Bacteria in the urine

ANS: 1 Feedback 1. The Reed-Sternberg cells are a diagnostic of Hodgkins disease. 2. Lymphocytes are naturally found in the bone marrow. 3. Neutrophils are naturally found in the blood to help fight infections. 4. Bacteria in the urine is not a confirmation of Hodgkins disease.

18. Which of the following is a reason to do a lumbar puncture on a child with a diagnosis of leukemia? 1. To assess the central nervous system for infiltration 2. To determine increased intracranial pressure 3. To stage the leukemia 4. To rule out meningitis

ANS: 1 Feedback 1. The abnormal cells of leukemia are definitive for the disease. 2. A lumbar puncture can increase ICP, not diagnose it. 3. Staging is done with blood cells, not cerebral spinal fluid. 4. If a child has a known diagnosis of leukemia, the lumbar puncture does not need to be done to identify meningitis unless other blood tests indicate infection.

55. A father brings his 3-year-old daughter to the cancer treatment center for a follow-up appointment. The previous rounds of chemotherapy were not successful in treating his daughters cancer. The plan is to provide an allogeneic transplantation. The father verbalizes an understanding of the process when he states: 1. An allogeneic transplant puts my daughter as the lowest risk for rejection. 2. I will need to get high doses of chemotherapy for the bone marrow to be appropriate for my daughters body. 3. I will need to be in isolation after the donation procedure. 4. My daughter will need a transplant from her mother and myself to be successful in curing the disease.

ANS: 1 Feedback 1. The allogeneic transplant has the lowest risk of rejection and would be appropriate for the child. 2. The receiver needs the high doses of chemotherapy, not the donor. 3. The daughter will need to be in isolation after the donation to help decrease the risk for infection because the chemotherapy increases her susceptibility to infection. 4. The transplant can come from the mother or the father. The important factor is having an allogeneic match.

33. A mother has called the triage nurse of the pediatric clinic to ask what she should do for her sons frequent epistaxis episodes. The treatment should include: 1. Having the child sit up with his head tilted forward so that blood does not go down the throat. 2. Encouraging the child to breathe through his nose. 3. Having the child attempt to keep his nose clean. 4. Applying heat to the nares.

ANS: 1 Feedback 1. The blood could be aspirated, so sitting forward will help decrease the occurrence. 2. Breathing through the nose can cause increased pressure and not stop the bleeding. 3. Cleansing and digging in the nose can cause clots to break and cause continued bleeding. 4. Ice should be applied to vasoconstrict the blood vessels to stop the bleeding.

14. The most frequent presenting signs of leukemia are related to bone marrow infiltration. The main symptoms are: 1. Anemia, infection, and bleeding. 2. Thrombocytopenia, headache, and abdominal pain. 3. Respiratory distress and pain. 4. Confusion and decreased peripheral vascular resistance.

ANS: 1 Feedback 1. The normal bone marrow is replaced with abnormal cells, leading to decreased red blood cells and anemia. The risk of infection relates to the lack of white blood cells and the reduction in platelets of thrombocytopenia. 2. The normal bone marrow is replaced with abnormal cells, leading to decreased red blood cells, which causes ischemia and pain. The risk of infection relates to the lack of white blood cells and the reduction in platelets of thrombocytopenia. Headaches are not a common sign. 3. The normal bone marrow is replaced with abnormal cells, leading to decreased red blood cells, which causes pain. The patient rarely exhibits signs of respiratory distress. 4. Neurological issues and peripheral vascular resistance are rare.

19. A child with cancer has a platelet count of 4,500/mm3. Which of the following should the nurse prepare to administer? 1. Platelets 2. Packed red blood cells 3. Neupogen 4. Erythropoeitin.

ANS: 1 Feedback 1. The normal level of platelets in greater than 5000/mm3. The child is at a high risk for bleeding, thus platelets are needed to help build clotting factors. 2. PRBCs will not increase clotting time. It will help increase the red blood cell carrying capacity of oxygen. 3. Neupogen stimulates the production of red blood cells. 4. Erythropoietin stimulates bone marrow to produce red blood cells.

25. Which nursing action is implemented first when a child is admitted to the transplant center for a hematopoietic stem cell transplant? 1. Prepare the child and family for an intensive ablative dose of chemotherapy. 2. Place the child in protective isolation. 3. Maintain a central line catheter. 4. Serve irradiated food and water to the child.

ANS: 1 Feedback 1. The preparation of the child and the caregivers for the weeks of hospitalization and social isolation required is a priority. A discussion with the child and caregivers will include the factors of the critical period of recovery for the client from the removal of cancer cells, transfusing histocompatible stem cells, and monitoring for signs of rejection. 2. Isolation is not the top priority at this time. 3. It is not stated that the child has a central line at this time, thus it is not a priority. 4. The concentration should be on the preparation of what is going to occur and how goals will be met.

15. A toddler with cancer has a central line catheter for chemotherapy. The priority for the nurse is to: 1. Administer nutrition using the central line. 2. Provide privacy during medication administration. 3. Use the central line to administer antibiotics. 4. Limit visitors to family members.

ANS: 1 Feedback 1. The priority is the prevention of infection during the care of the child as well as making sure that the child has adequate procedures to prevent infection when using the central line. 2. Privacy is important for all patients. 3. The central line can be used for nutrition and medication administration. 4. Additional precautions do not need to be taken for visitors at this time.

32. Which of the following should the nurse include when teaching the mother of a 9-month-old infant about administering liquid iron preparations? 1. Adequate dosage will turn the stools a tarry green color. 2. Stop immediately if nausea and vomiting occur. 3. Give the medication with meals. 4. Allow the preparation to mix with saliva and bathe the teeth before swallowing.

ANS: 1 Feedback 1. The side effect of oral iron supplements is tarry green stools. 2. Nausea and vomiting are not common side effects of iron supplementation. 3. The medication should be spaced out from the meals to decrease the chance for nausea and vomiting. 4. Most infants do not like the taste of iron supplements and will spit it out if mixed with the saliva.

47. A father of an 18-month-old boy reports that his son has been constipated, has pain in his abdomen when touched, and seems lethargic since they moved to a new house. The nurse should asses if the environment: 1. Contains lead-based paint. 2. Has pollen in the area surrounding the house. 3. Is near a factory. 4. Is near power lines.

ANS: 1 Feedback 1. The symptoms are common with exposure to lead-based paint, and the nurse should anticipate a blood test. 2. Pollen may cause sneezing as well as watery, itchy eyes, but not the symptoms described. 3. Living near a factory may cause environmental hazards, but the child is showing signs of lead poisoning. 4. The child is showing signs of lead poisoning, which is not found near power lines.

48. A common opportunistic infection for a child with immune suppression related to HIV is: 1. Tuberculosis. 2. Syphilis. 3. Meningitis. 4. E. Coli

ANS: 1 Feedback 1. Tuberculosis is one of the most common opportunistic infections in children with HIV. 2. Syphilis is not common in children with HIV. 3. Meningitis is not common in children with HIV. 4. E. Coli may be present in the GI tract, but does not commonly cause further complications for children with HIV.

58. Identify food sources that are recommended for children to receive iron. Select all that apply. 1. Spinach 2. Broccoli 3. Carrots 4. Chicken breasts 5. Chick peas

ANS: 1, 2 Feedback 1. Green spinach is an iron source. 2. Broccoli is an iron source. 3. Carrots have beta-carotene and fiber, not iron. 4. Chicken breasts do not contain iron, but are a good source of protein. 5. Chick peas are not a good source of iron.

57. You are caring for a client who is receiving a bone marrow transplant to treat cancer. Important aspects of care to consider include: (Select all that apply.) 1. A patient receiving BMT is immune-suppressed and should be on reverse precautions. 2. BMT is done as a first line of treatment for children with cancer. 3. BMT should be given to the patient after they have received chemotherapy or radiation treatment so that his/her newly given healthy cells are not harmed. 4. Donor matches do not have to be exact and are easily found. 5. There are three major types of BMT, including allogeneic, autologous, and peripheral stem cell transplant (PSCT).

ANS: 1, 3, 5 Feedback 1. Reverse precautions help the patient to not get infections from other individuals. 2. BMT is usually a last resort for treatment. 3. Chemotherapy and radiation kill cells, so the BMT should be done after this to keep the healthy cells alive. 4. Donor matches are difficult to find, and an exact match must be used. 5. The three types of BMT can benefit many different patients.

17. The laboratory test ordered to determine the presence of the Human Immunodeficiency Virus antibodies is a: 1. Complete blood cell count. 2. Western blot immunoassay. 3. Bone marrow aspiration. 4. Biopsy of the tumor.

ANS: 2 Feedback 1. A complete blood cell count is a common test to identify other types of infections and anemia. 2. The Western blot test confirms the presence of Human Immunodeficiency Virus antibodies. 3. A bone marrow aspiration is used in patients with cancer, not HIV. 4. A tumor biopsy is not a common test for identifying a patient with HIV.

8. What is included in neurologic checks for children of all ages with a brain tumor? 1. Papillary response, head circumference, vital signs 2. Motor activity, papillary response, vital signs 3. Level of consciousness, palpate fontanels, motor activity 4. Blood pressure, head circumference, level of consciousness

ANS: 2 Feedback 1. A head circumference is not an indicated neurological check for all ages of children. 2. The indicators of the neurological system for all ages include a widening pulse pressure, papilledema, and the ability to move each extremity. 3. Vital signs need to be assessed in a child with a brain tumor to closely monitor changes in pulse pressures. Older children will have closed fontanels. 4. Head circumference is not measured in all children.

30. What type of bone marrow transplant must have compatible human leukocyte antigen in both the donor and recipient? 1. Intravenous transplant 2. Allogeneic 3. Autologous 4. Peripheral stem cell transplant

ANS: 2 Feedback 1. An intravenous transplant does not require compatible human leukocyte antigens. 2. Allogeneic transplants have to be compatible in order to decrease the risk for rejection. 3. Autologus does not have the same human leukocyte antigen and increases the chance for rejection. 4. Stem cell transplants must be from the childs own stem cells in order to have compatibility.

2. Classic hemophilia (hemophilia A) involves a deficiency in: 1. Factor V. 2. Factor VIII. 3. Factor IX. 4. Factor XIII.

ANS: 2 Feedback 1. Factor V is not noted in hemophilia A. 2. Administration of Factor VIII, derived from pooled plasma, will increase the clotting ability of the body. 3. Factor IX is not an issue with hemophilia A. 4. Factor XIII is not a factor in hemophilia A

1. Which of the following is a condition in which the normal hemoglobin is partially or completely replaced by abnormal hemoglobin? 1. Iron deficiency anemia 2. Sickle Cell anemia 3. Leukemia 4. Aplastic anemia

ANS: 2 Feedback 1. Iron deficiency anemia occurs because there is not enough iron to support the production of hemoglobin. 2. Sickle Cell anemia has abnormal hemoglobin S. The deformed cell changes from a round shape to a sickle shape. 3. Leukemia a disease process that causes the destruction of hemoglobin. 4. Aplastic anemia occurs because the bone marrow is not producing enough red blood cells, making the patient anemic.

45. Parents of a child with hemophilia want to have a second child. Genetic testing is recommended because: 1. The disease is carried by a dominant X-linked gene. 2. The disease is a mutation and has a low occurrence with subsequent pregnancies. 3. The X-linked recessive trait must be present in both parents, and a subsequent child may have the same disorder. 4. The Y-linked recessive trait causes the disease to occur and will happen in subsequent pregnancies.

ANS: 3 Feedback 1. The disease is carried by an X-linked recessive gene. 2. The disease has a high occurrence if both parents are carriers. 3. The X-linked recessive trait must be present in both parents to occur. 4. The X-linked recessive trait is the carrier, not the Y-linked trait.

34. A 6-month-old patient is admitted for iron deficiency anemia. The nurse knows that the child was put at risk for developing the illness when the mother states: 1. I have a house that does not have lead-based paint. 2. He drinks milk instead of formula because it is cheaper. 3. I make sure to monitor the amount of juice intake. 4. I provide water in his bottles one time a day.

ANS: 2 Feedback 1. Lead-based paint can lead to lead poisoning, not anemia. 2. A 6 month old is not able to store iron. Milk is not fortified with iron, thus creating the deficiency for the child. The child should remain on formula until at least 12 months of age. 3. Juice provides empty calories and nutrients and should not be given to an infant. 4. Water should not be given to an infant because it fills the stomach, and the child does not receive the needed nutrition from the formula.

46. The mother of a 16-year-old teen with hemophilia calls the nurse triage and asks if it is appropriate to give her son a dose of NSAIDS to reduce his fever. The nurse knows that: 1. NSAIDS are the most effective treatment for fever reduction and should be given to the teen. 2. NSAIDS are not recommended because it may interfere with platelet formation. 3. NSAIDS are not recommended because they can cause Reyess Syndrome. 4. NSAIDS are only effective when given with large amounts of water.

ANS: 2 Feedback 1. NSAIDS can interfere with platelet formation in patients with hemophilia. 2. Instruction on not giving the medication because of the risk of platelet formation interference is needed. 3. At 16 years of age, Reyes Syndrome is decreased. NSAIDS interfere with the production of platelets for hemophiliacs. 4. NSAIDS do not need to be given with large amounts of water in order to be effective.

6. Which of the following events places a preschool child at high risk for lead poisoning? 1. Using pencils and pens 2. Living in a home built before 1965 3. Drinking from the water fountain at school 4. Climbing on playground equipment

ANS: 2 Feedback 1. Pencils and pens contain a low lead content. 2. Paint used in homes before 1965 contained lead, and the paint has not been removed. 3. Water is tested for lead levels and does not place the child at high risk. 4. Playground equipment has low levels of lead.

31. Which of the following is an accurate description of the physiologic defect caused by anemia? 1. Presence of abnormal hemoglobin 2. Decreased oxygen carrying capacity of blood 3. Increased blood viscosity 4. Depressed hematopoietic system

ANS: 2 Feedback 1. The abnormal hemoglobin may be present, but it contributes to anemia and is not caused by it. 2. The lack of oxygen carrying capacity is a physiological defect caused by the anemia. 3. Anemia causes the viscosity. 4. The decrease in the hematopoietic system is caused by the lack of production, not anemia.

39. A nurse is discussing the process of hematopoiesis with a new nurse. It is important for the new nurse to understand that: 1. Red blood cells live for less than five days. 2. Red blood cells are produced with erythropoietin and iron. 3. Red blood cells develop in the long bones. 4. Hemolysis of red blood cells occurs in the kidneys.

ANS: 2 Feedback 1. The red blood cells life span does not influence the hematopoiesis process. 2. Erythropoeitin and iron are included in the process of hematopoiesis. 3. Red blood cell production occurs in the bone marrow. 4. Hemolysis of red blood cells does not affect hematopoiesis.

40. An 11-year-old child has been brought to the emergency room because the mother has noted petechiae on his elbows. When the nurse assesses the child, she notes that the boy has purpura on his legs. What action should be taken? 1. Notify the doctor of the medical emergency. 2. Assess if the child has had hematemesis. 3. An abuse investigation should be discussed with a social worker. 4. All of the above would be correct actions.

ANS: 2 Feedback 1. This is not a medical emergency, but should be assessed. 2. The signs are consistent with hematemesis. 3. Because of where the marks are on the childs body, further assessment is needed before notifying a social worker. 4. The signs are consistent with hematemesis.

41. The doctor has prescribed an injection of solu-medrol and occult of all stools for a child with acquired thrombocytopenia. Why should the nurse question the order? 1. Blood in the stools is rare with this illness. 2. Steroids are not an effective treatment. 3. Injections should not be given to a child with this condition. 4. None of the orders are appropriate for a child with this illness.

ANS: 3 Feedback 1. Blood in the stools is possible with this disease process. 2. Steroids are a common treatment for thrombocytopenia. 3. Injection can further exacerbate the condition and should not be given to the child. 4. An injection should not be given to the child.

16. Common adverse effects of chemotherapy are nausea and vomiting. As a result, the nurse should initiate which of the following nursing actions? 1. Remove food with a lot of color. 2. Wait until the nausea begins to administer the antiemetic as ordered. 3. Give an antiemetic 30 minutes before the start of chemotherapy. 4. Establish a nothing by mouth status during chemotherapy.

ANS: 3 Feedback 1. Food in general may make the child have nausea and cause vomiting. 2. An antiemetic should be provided 30 minutes prior to chemotherapy to prevent the feelings of nausea and vomiting. 3. The onset of the antiemetic will occur with the start of chemotherapy and prevent nausea. 4. The patient can have food throughout chemotherapy if they feel well enough for food.

37. A mother asks the nurse why a reticulocyte test is performed on her daughters blood. The nurse knows the reticulocyte test will indicate: 1. White blood cell production. 2. Hemoglobin production. 3. Red blood cell production. 4. Hematocrit production.

ANS: 3 Feedback 1. Reticulocyte tests indicate red blood cell production. 2. The reticulocytes are the immature red blood cells that will indicate if enough is going to be produced. 3. The reticulocyte test is the smallest form that measures for red blood cell production. 4. The reticulocyte test is the smallest form that measures for red blood cell production.

23. A child undergoing radiation therapy for cancer has a nursing diagnosis of risk for impaired skin integrity. What is a priority nursing action? 1. Cover the wound with a sterile dressing. 2. Use mild soap on the radiation area. 3. Use water to cleanse the area and leave markings on the skin. 4. Use antiseptic soap to cleanse the area.

ANS: 3 Feedback 1. The diagnosis is a risk, so an actual wound would not be present. 2. Soap may irritate the skin, and the markings are needed for future radiation treatments. 3. Water will not irritate the skin, and the markings are needed for future radiation treatments. 4. Antiseptic soap will irritate the skin, and the markings are needed for future radiation treatments.

44. A mother is asking questions about the type of diet her child should be receiving with the diagnosis of aplastic anemia. The nurse informs the mother that the childs diet should include: 1. Hamburgers and french fries. 2. Carrots and potatoes. 3. Turkey sandwiches and spinach salads. 4. Macaroni and hamburger casseroles.

ANS: 3 Feedback 1. The fat content of the french fries should be avoided. 2. These are part of a healthy diet, but do not contain high levels of iron or protein. 3. The protein from the turkey and the iron from the spinach are appropriate for this child. 4. The macaroni has empty nutrients for a child with aplastic anemia.

27. A nurse sees a new nurse on the floor handling chemotherapy medications without gloves or protective clothing. What should the nurse do first? 1. Talk about it with other employees at the nurses station later that day. 2. Nothing. The new nurse is doing nothing wrong. 3. Remind the new nurse that it is not safe to handle these medications without protective clothing. 4. Report the new nurse to the supervisor for unsafe use of medications.

ANS: 3 Feedback 1. The nurse needs to speak directly with the new nurse to teach her about the safe handling of chemotherapy agents. 2. The new nurse needs education on how to handle chemotherapy agents. 3. Reminding the new nurse will help facilitate learning on how to handle chemotherapy agents. 4. The issue should be directly discussed with the new nurse.

20. A child with the diagnosis of AML is receiving chemotherapy. The platelet count is 10,000/mm3. The teaching plan for the caregiver should include: 1. Maintaining isolation precautions. 2. Visitors being limited with visiting time. 3. Using a soft toothbrush for mouth care. 4. An assessment of the vital signs every four hours.

ANS: 3 Feedback 1. The platelet count is not in a range to need precautions at this time. 2. The patient may be tired, but visiting times do not need to be limited. 3. The soft toothbrush will minimize bleeding while performing mouth care. 4. Vital signs need to occur per protocol and as frequently as the patients status renders.

35. The nurse has received hemoglobin and hematocrit levels for a 7-year-old patient. The results are HGB 9.0 and HCT 28 percent. These results indicate: 1. A normal HGB and HCT. 2. A high HGB and low HCT. 3. A low HGB and low HCT. 4. A low HGB and normal HCT.

ANS: 3 Feedback1.The HGB and HCT are low for a child this age. Intervention is needed.2.The HGB is low, and intervention is needed.3.The values are low. The family requires education on how to increase the hemoglobin and hematocrit levels.4.The HCT is low, and an intervention is needed.

13. Jordan is 10 years old and has hemophilia. The discharge instructions should include teaching about participation in which of the following activities? 1. Football 2. Soccer 3. Baseball 4. Swimming

ANS: 4 Feedback 1. Football has an increased risk for internal bleeding and should be avoided. 2. Soccer places the child at an increased risk for internal bleeding and should be avoided. 3. Baseball puts the child at increased risk for injury and should be avoided. 4. To lower the risk for internal bleeding, the child can participate in noncontact sports, such as swimming.

38. The nurse is providing education about giving iron supplements to a 2-year-old child. The nurse should include none of the following except: 1. Giving the supplements one hour prior to letting the child drink milk. 2. Noting that diarrhea may be present at first. 3. Giving the supplements with vitamin D to increase absorption. 4. Stools may be black

ANS: 4 Feedback 1. Milk does not influence the absorption of iron. 2. Constipation is more common than diarrhea when taking iron supplements. 3. Vitamin D will not increase absorption. 4. Iron supplementation can cause black stools in toddlers.

29. A 4-year-old boy comes into the emergency department with multiple bruises on his body, excessive nausea, headaches that lead to vomiting, persistent localized pain, and is very pale. Identify the one symptom that is not a cardinal sign of cancer. 1. Paleness 2. Bruises 3. Headaches 4. Excessive nausea

ANS: 4 Feedback 1. Pale skin tone is common. 2. Bruises appear when no injury has occurred in children with cancer. 3. Excessive headaches can indicate tumor growth in children with cancer. 4. Excessive nausea is not common in children with cancer.

12. A 12 year old is admitted with a Sickle Cell crisis. Which of the following is the priority nursing diagnosis? 1. High risk for dehydration 2. Impaired airway 3. Inappropriate grieving 4. Pain related to tissue ischemia

ANS: 4 Feedback 1. The admitting diagnosis does not indicate if the child is dehydrated, thus this is not the proper diagnosis at this time. 2. The airway is not usually compromised in a child with a Sickle Cell crisis. 3. The Sickle Cell crisis may cause the child to grieve, but this is not the priority at this time. 4. The pain from the decreased oxygen carrying capacity of the cells causes distress. Comfort measures, including medication and warm, moist heat, must be considered.

22. The laboratory results of a child with AML indicate a white blood cell count of 500 with two percent bands. Which of the following responses is appropriate? 1. Administer the Hepatitis B vaccine as ordered. 2. Prepare for hemolytic reactions. 3. Visitors can bring flowers and gifts of fruit to the child. 4. Have people wash their hands prior to contact with the child.

ANS: 4 Feedback 1. The child is at high risk for infection and vaccinations are not recommended. 2. The child is at risk for infection. 3. Flowers and fruit can bring in bacteria and should be avoided. 4. The child is at high risk of infection because he/she does not have an adequate white blood cell count of greater than 500, and the bands are immature white cells.

24. A 7-year-old child has been hospitalized for treatment for leukemia. Which nursing action is most appropriate for the childs nutrition? 1. Offer only foods that the child likes. 2. Turn on the television for distraction while eating. 3. Offer juice or popsicles every two hours. 4. Have caregivers visit at mealtime.

ANS: 4 Feedback 1. The child may not want the foods that are the most nutritious, thus requiring the offer of other foods. 2. The television should be off in order to encourage concentration on eating. 3. Juice and popsicles provide empty calories. A concentration on nutritious foods should be made. 4. The caregivers can offer emotional, social, and psychological support to enhance nutritional intake.