Pediatric Success: Hematology/Oncology

Wilms tumor

-malignant tumor of the kidney occurring in childhood -Never palpate the abdomen to prevent seeding the tumor

1. The nurse is taking care of a child with sickle cell disease. The nurse is aware that which of the following problems is (are) associated with sickle cell disease? Select all that apply. 1. Polycythemia. 2. Hemarthrosis. 3. Aplastic crisis. 4. Thrombocytopenia. 5. Vaso-occlusive crisis.

1. 3, 5 1. Polycythemia is seen in children with chronic hypoxia, such as cyanotic heart disease. 2. Hemarthrosis, bleeding into a joint, is commonly seen in children with hemophilia. 3. Aplastic crisis, temporary cessation of red blood cell production, is associated with sickle cell anemia. 4. Thrombocytopenia is associated with idiopathic thrombocytopenia purpura, high altitude, medication side effects, and pregnancy. 5. Vaso-occlusive crisis is the most common problem in children with sickle cell disease.

10. The nurse is caring for a child with leukemia. The nurse should be aware that children being treated for leukemia may experience which of the following complications? Select all that apply. 1. Anemia. 2. Infection. 3. Bleeding tendencies. 4. Bone deformities. 5. Polycythemia.

10. 1, 2, 3. 1. Anemia is caused by decreased production of red blood cells. 2. Infection risk in leukemia is secondary to the neutropenia. 3. Bleeding tendencies are from decreased platelet production. 4. There are no bone deformities with leukemia, but there is bone pain from the proliferation of cells in the bone marrow. 5. Polycythemia is an increase in red blood cells. TEST-TAKING HINT: Leukemia is cancer of the blood forming organs. Leukemia can be either acute or chronic. Review the pathophysiology of leukemia to determine the clinical problems.

11. Which of the following is a reason to perform a lumbar puncture on a child with a diagnosis of leukemia? Select all that apply. 1. Rule out meningitis. 2. Assess the central nervous system for infiltration. 3. Give intrathecal chemotherapy. 4. Determine increased intracranial pressure. 5. Stage the leukemia.

11. 2, 3. 1. There is no need to perform a spinal tap to rule out meningitis unless the patient has symptoms of meningitis. 2. A lumbar puncture is done to determine whether the cancer cells have entered the CNS, but this would not be routine unless the child was symptomatic. 3. Chemotherapy can also be given through a lumbar puncture (spinal tap). 4. ICP would be considered if the child had symptoms of headache, nausea, forceful vomiting, blurred or double vision, drowsiness, or seizure; an LP might then be performed. 5. Leukemia is not staged. TEST-TAKING HINT: The primary site for leukemia involvement is the bone marrow. Rarely do children have CNS involvement.

13. Which of the following can be a manifestation of leukemia in a child? Select all that apply. 1. Leg pain. 2. Fever. 3. Excessive weight gain. 4. Bruising. 5. Enlarged lymph nodes.

13. 1, 2, 4, 5. 1. The proliferation of cells in the bone marrow can cause leg pain. 2. Fever is a result of the neutropenia. 3. There is usually a decrease in weight because the child will feel sick and not as hungry. 4. A decrease in platelets causes the bruising. 5. The lymph nodes are enlarged by the infiltration of leukemic cells. TEST-TAKING HINT: Review the consequences of depressed bone marrow and relate them to the clinical manifestations.

14. Which of the following can lead to a possible diagnosis of human immunodeficiency virus (HIV) in a child? Select all that apply. 1. Repeated respiratory infections. 2. Intermittent diarrhea. 3. Excessive weight gain. 4. Irregular heartbeat. 5. Poor weight gain.

14. 1, 2, 4, 5. 1. Symptoms of HIV include frequent respiratory infections. The symptoms present based on the underlying cellular immunodeficiency-related disease. 2. Symptoms of HIV include intermittent diarrhea. The symptoms present based on the underlying cellular immunodeficiency-related disease. 3. Children with HIV are unable to create an immune response to infection. They develop recurrent bacterial infections and have poor weight gain. The symptoms present based on the underlying cellular immunodeficiencyrelated disease. 4. Irregular heartbeat is not associated with HIV. 5. Symptoms of HIV include poor weight gain. TEST-TAKING HINT: Symptoms of HIV in children include lymphadenopathy, hepatosplenomegaly, chronic diarrhea, failure to thrive, and parotitis. Review common clinical signs and health conditions associated with the virus.

15. A nurse is caring for a 15-year-old who has just been diagnosed with non-Hodgkin lymphoma. Which of the following should the nurse include in teaching the parents about this lymphoma? Select all that apply. 1. The malignancy originates in the lymphoid system. 2. The presence of Reed-Sternberg cells in the biopsy is considered diagnostic. 3. Mediastinal involvement is typical. 4. The disease is diffuse rather than nodular. 5. Treatment includes chemotherapy and radiation.

15. 1, 3, 4, 5. 1. Non-Hodgkin disease originates in the lymphoid system. 2. Reed-Sternberg cells are diagnostic for Hodgkin disease and are not seen in nonHodgkin lymphoma. Reed-Sternberg cells arise from "B" cells and are large, multinucleated cells. 3. Mediastinal involvement is typical. 4. The disease is diffuse rather than nodular. 5. Treatment includes chemotherapy and radiation. TEST-TAKING HINT: The lymphomas are divided into Hodgkin disease (which primarily involves the lymph nodes with metastasis to extra lymphatic sites) and non-Hodgkin lymphoma (a heterogenous condition that has a variety of morphological, cytochemical, and immunological cell features).

16. The most important reason health-care providers prescribe a combination of antiretroviral drugs to children with HIV is to delay: 1. Progression to AIDS. 2. Enable treatment of multiple symptoms. 3. Recurrence of symptoms. 4. Drug resistance.

16. 4. 1. Indirectly the use of multiple antiretroviral medications does minimize progression to a diagnosis of AIDS, but each of the drugs alone cannot control the progression. 2. The symptoms of HIV will be resolved once the antiretroviral therapy begins to decrease the viral load. 3. There is no way to predict if and when recurrence will occur. Taking antiretroviral medications and maintaining a healthy life style is the best way to decrease the risk of the symptoms. 4. A combination of antiretroviral medications is prescribed for a child who is HIV positive to delay development of drug resistance. HIV drugs work on different stages of the HIV life cycle to prevent reproduction of new virus particles. TEST-TAKING HINT: The importance of maintaining medications that assist in treatment and do not develop resistance is essential to controlling the virus.

18. Which of the following is the most effective treatment for pain in a child with sickle cell crisis? Select all that apply. 1. Meperidine (Demerol). 2. Aspirin. 3. Morphine. 4. Behavioral techniques. 5. Acetaminophen (Tylenol) with codeine.

18. 3, 4, 5. 1. Meperidine (Demerol) should not be used because it may potentiate seizures. 2. Aspirin should not be used in children because of the risk for Reye syndrome. 3. Morphine is the drug of choice for a child with sickle cell crises. Usually the child is started on oral doses of acetaminophen (Tylenol) with codeine. When that is not sufficient to alleviate pain, stronger narcotics are prescribed, such as morphine. Ketorolac (Toradol) may be indicated for short-term use for moderate-severe pain. 4. Behavioral techniques such as positive self-talk, relaxation, distraction, and guided imagery are helpful when pain is occurring. 5. Usually the child is started on oral doses of acetaminophen (Tylenol) with codeine when pain is described as mild to moderate. TEST-TAKING HINT: One needs to consider using narcotics when a child has sickle cell crises, because tissue hypoxia can cause severe pain.

19. The nurse is caring for a child with sickle cell disease who is scheduled to have an exchange transfusion. What information should the nurse teach the family? 1. The procedure is done to prevent further sickling during a vaso-occlusive crisis. 2. The procedure reduces side effects from blood transfusions. 3. The procedure is a routine treatment for sickle cell crisis. 4. Once the child's spleen is removed, it is not necessary to do exchange transfusions

19. 1. Exchange transfusion reduces the number of circulating sickle cells and slows down the cycle of hypoxia, thrombosis, and tissue ischemia. 2. Exchange transfusion does not decrease risk of a transfusion reaction. Every time a transfusion is done, the child continues to be at risk for a reaction. 3. This is not a routine procedure and is performed only when the number of sickle cells is elevated and the child is at high risk for thrombosis. 4. After a splenectomy, transfusions still need to be done depending on the client's hemoglobin level. TEST-TAKING HINT: Consider the reasons transfusions are given with sickle cell clients, one of which is exchanging the sickled red cells with non-sickled cells.

2. An 18-month-old male is brought to the clinic by his mother. His height is in the 50th percentile, and his weight is in the 80th percentile. The child is pale. The physical examination is normal, but his hematocrit level is 20%. Which of the following questions should assist the nurse in making a diagnosis? Select all that apply. 1. "How many bowel movements a day does your child have?" 2. "How much did your baby weigh at birth?" 3. "What does your child eat every day?" 4. "Has the child been given any new medications?" 5. "How much milk does your child drink per day?"

2. 3, 5 1. Because the child has a low hematocrit level, the child most likely has anemia. Iron-deficiency anemia is the most common nutritional anemia. The number of bowel movements the child has is important information but not necessary to make the diagnosis of iron-deficiency anemia. 2. Knowing birth weight can help determine whether the child is following his or her own curve on the growth chart. 3. A diet history is necessary to determine the nutritional status of the child and whether the child is getting sufficient sources of iron. 4. Knowing if the child is taking any new medication is not necessary to make the diagnosis of iron-deficiency anemia. 5. By asking how much milk the child consumes, the nurse can determine whether the child is filling up on milk and then not wanting to take food. TEST-TAKING HINT: The most common anemia in children and in toddlers is irondeficiency anemia, frequently the result of drinking too much milk and not eating enough iron-rich foods.

21. A 10-year-old with severe factor VIII deficiency falls, injures an elbow, and is brought to the ED. The nurse should prepare which of the following? 1. An IM injection of factor VIII. 2. An IV infusion of factor VIII. 3. An injection of desmopressin. 4. An IV infusion of platelets.

21. 1. Factor VIII is not given intramuscularly. 2. The child is treated with an IV infusion of factor VIII to replace the missing factor and help stop the bleeding. 3. Desmopressin is given to stimulate factor VIII production, and it is given intravenously. 4. Platelets are not affected in hemophilia. TEST-TAKING HINT: Focus on the diagnosis of hemophilia: A deficiency in factor VIII causes continued bleeding with an injury.

22. Which of the following will be abnormal in a child with the diagnosis of hemophilia? 1. Platelet count. 2. Hemoglobin level. 3. White blood cell count. 4. Partial thromboplastin time (PTT).

22. 1. Platelet function is normal in hemophilia. 2. There is no change in hemoglobin with a diagnosis of hemophilia. The hemoglobin will drop with bleeding. 3. The white blood cell count does not change with hemophilia. 4. The abnormal laboratory results in hemophilia are related to decreased clotting function. Partial thromboplastin time is prolonged. TEST-TAKING HINT: Use the process of elimination to determine the test that indicates a decrease in clotting.

24. Which of the following measures should the nurse teach the parent of a child with hemophilia to do first if the child sustains an injury to a joint causing bleeding? 1. Give the child a dose of acetaminophen (Tylenol). 2. Immobilize the joint and elevate the extremity. 3. Apply heat to the area. 4. Administer factor per the home-care protocol

24. 1. Acetaminophen (Tylenol) helps with the pain but does not stop the bleeding. 2. Elevating and immobilizing the extremity are good interventions as they decrease blood flow. Factor should be administered first, however. 3. Cold, not heat, should be applied to promote vasoconstriction. 4. Administration of factor should be the first intervention if home-care transfusions have been initiated. TEST-TAKING HINT: Treatment of hemophilia is to provide factor replacement as soon as possible after a bleed has started. Application of cold, elevation of extremities, and application of pressure for 10 to 15 minutes are all good interventions after the factor is given..

26. A nurse educator is providing a teaching session for the nursing staff. Which of the following individuals is at greatest risk for developing beta-thalassemia (Cooley anemia)? 1. A child of Mediterranean descent. 2. A child of Mexican descent. 3. A child whose mother has chronic anemia. 4. A child who has a low intake of iron.

26. 1. Beta-thalassemia is an inherited recessive disorder that is found primarily in individuals of Mediterranean descent. The disease has also been reported in Asian and African populations. 2. It is not found often in the Mexican population. 3. This is a hereditary disease that causes chronic anemia. The mother should have had thalassemia for this answer to be correct. 4. This disorder has nothing to do with iron deficiency. TEST-TAKING HINT: Use the process of elimination, knowing that the disorder is a hereditary disorder in those of Mediterranean descent.

28. The nurse is caring for a child diagnosed with thalassemia major who is receiving the first chelation therapy. What information should the nurse provide to the parent regarding the therapy? Select all that apply. 1. Decreases the risk of bleeding. 2. Eliminates excess iron. 3. Prevents further sickling of the red blood cells. 4. Provides an iron supplement. 5. Hydration is necessary for the process to be effective.

28. 2, 5. 1. There are no bleeding tendencies in thalassemia major (beta-thalassemia or Cooley anemia), and chelation does not affect clotting. 2. Chelation therapy is used to rid the body of excess iron stores that result from frequent blood transfusions. 3. There is no sickling of red blood cells in thalassemia, and chelation therapy has no direct effect on red blood cells. 4. Chelation does not provide an iron supplement. 5. Hydration is necessary for the process to be effective. TEST-TAKING HINT: Focus on the treatment of beta-thalassemia and how chelation therapy works.

29. Which of the following should the nurse expect to administer to a child with ITP and a platelet count of 5000/mm 3 ? Select all that apply. 1. Platelets. 2. Intravenous immunoglobulin. 3. Packed red blood cells (PRBCs). 4. White blood cells. 5. Prednisolone.

29. 2, 5. 1. In ITP, destruction of platelets is caused from what is believed to be an immune response, so giving additional platelets would only result in new platelets being destroyed. 2. Intravenous immunoglobulin is given because the cause of platelet destruction is believed to be an autoimmune response to disease-related antigens. Treatment is usually supportive. Activity is restricted at the onset because of the low platelet count and risk for injury that could cause bleeding. 3. Red blood cells are not an effective treatment for ITP. 4. Because this is a platelet deficiency, white blood cells are not an effective treatment for ITP. White blood cell infusion is rarely done with any disease process. 5. Treatment in the acute phase is often symptomatic, and prednisolone, IVIG, and anti-D antibody are often given. This tends to shorten the course because the disease tends to resolve over time. Focus on the cause of ITP and which cells are affected.

38. School-age children with cancer often have a body image disturbance related to hair loss, moon face, or debilitation. Which of the following interventions is (are) most appropriate? Select all that apply. 1. Encourage them to wear a wig similar to their own hairstyle. 2. Emphasize the benefits of the therapy they are receiving. 3. Have them play only with other children with cancer. 4. Use diversional techniques to avoid discussing changes in the body because of the chemotherapy. 5. Help them find a "special friend" who understands what they are experiencing.

38. 1, 5. 1. Wearing a wig is a good way for the child to keep personal identity despite the loss of hair. 2. Just discussing the benefits of the therapy will not help the child with self-image. 3. Having the child play only with other children with cancer could make the child feel even worse because of the inability to interact with friends. The child needs to find acceptance as appearance begins to change. 4. Diverting the child's attention would be avoiding the truth and would not be dealing with the issues. 5. Children with cancer and body-image changes oftentimes need assistance in expressing themselves, which a "special friend" can help with.

39. The nurse receives a call from a parent of a child with leukemia in remission. The parent says the child has been exposed to chickenpox and has never had it. Which of the following responses is most appropriate for the nurse? Select all that apply. 1. "You need to monitor the child's temperature frequently and call back if the temperature is greater than 101°F (38.3°C)." 2. "The child has had two varicella immunizations as an infant but is no longer immune after chemotherapy." 3. "You need to bring the child to the clinic for a varicella immunoglobulin vaccine." 4. "Your child will need to be isolated for the next 2 weeks." 5. "Your child may develop chicken pox lesions about 14 to 21 days after exposure."

39. 2, 3. 1. The temperature should always be monitored, but the child has been exposed to chickenpox. The child needs to be protected from getting the disease as it can be life threatening. 2. Chickenpox exposure is a real concern for a child who is immunocompromised, and action needs to be taken. 3. The child should receive varicella zoster immune globulin within 96 hours of the exposure. 4. Starting isolation at this time does not protect the child. 5. If the parent acts immediately and the child receives IVIG, the child will not develop the lesions of chicken pox. TEST-TAKING HINT: Review protective precautions that should be taken for immunocompromised children. Chickenpox can be deadly for these children.

4. A nurse is caring for a 5-year-old with sickle cell vaso-occlusive crisis. Which of the following orders should the nurse question? Select all that apply. 1. Position the child for comfort. 2. Apply hot packs to painful areas. 3. Give meperidine (Demerol) 25 mg intravenously every 4 hours as needed for pain. 4. Restrict oral fluids. 5. Apply oxygen per nasal cannula to keep oxygen saturations above 94%.

4. 3, 4, 5 1. Medical treatment of sickle cell vasoocclusive crises is directed toward preventing hypoxia. Tissue hypoxia is very painful, so placing the child in a position of comfort is important. 2. Hot packs help relieve pain because they cause vasodilation, which allows increased blood flow and decreased hypoxia. 3. Tissue hypoxia is very painful. Narcotics such as morphine are usually given for pain when the child is in a crisis. Meperidine (Demerol) should be avoided because of the risk of Demerol-induced seizures. 4. The child should receive hydration because when the child is in crisis, the abnormal S-shaped red blood cells clump, causing tissue hypoxia and pain. 5. Oxygen is of little value unless the tissue is hypoxic. The objective of treatment is to minimize hypoxia. TEST-TAKING HINT: Focus on the pathophysiology of a vaso-occlusive crisis. Keep in mind measures that decrease tissue hypoxia.

Beta thalassemia

4. In beta-thalassemia, there is increased destruction of red blood cells, causing anemia. This results in chronic anemia and hypoxia. The children are treated with multiple blood transfusions, which can cause iron overload and damage to major organs.

40. The nurse is caring for a child being treated for ALL. Laboratory results indicate that the child has a white blood cell count of 5000/mm 3 with 5% polys and 3% bands. Which of the following analyses is most appropriate? 1. The absolute neutrophil count is 400/mm 3 , and the child is neutropenic. 2. The absolute neutrophil count is 800/mm 3 , and the child is neutropenic. 3. The absolute neutrophil count is 4000/mm 3 , and the child is not neutropenic. 4. The absolute neutrophil count is 5800/mm 3 , and the child is not neutropenic.

40. 1. The calculated absolute neutrophil count is 400/mm 3 (0.08 × 5000), and the child is neutropenic because the count is less than 500/mm 3 . 2. The absolute neutrophil count is incorrectly calculated. The child would not be neutropenic with a count of 800/mm 3 . 3. The absolute neutrophil count is incorrectly calculated. The child would not be neutropenic with a count of 4000/mm 3 . 4. The absolute neutrophil count is incorrectly calculated. The child would not be neutropenic if the count were 5800/mm 3 . TEST-TAKING HINT: To calculate the absolute neutrophil count, multiply the white blood cell count by the percentage of neutrophils ("polys," "segs," and "bands"). For example: WBC = 1500/mm 3 , neutrophils = 7%, nonsegmented neutrophils (bands) = 7%. 7% + 7% = 14%. 0.14 × 1500 = 210/mm 3 ANC. Precautions for infection should be used at all times with children who are immunosuppressed, but greater precautions must be taken when the ANC is less than 500/mm 3

41. Which of the following is the best method to prevent the spread of infection to an immunosuppressed child? 1. Administer antibiotics prophylactically to the child. 2. Have people wash their hands prior to contact with the child. 3. Assign the same nurses to care for the child each day. 4. Limit visitors to family members only.

41. 1. Antibiotics should be used only if the child has a bacterial infection. 2. Hand washing is the best method to prevent the spread of germs and protect the child from infection. 3. All nurses should use the same techniques in caring for the child. Assigning the same nurses may not be possible. 4. Visitors should be screened for infection and communicable diseases, but visitors should not be limited to family members only. TEST-TAKING HINT: The first defense against infection is prevention. Strict hand-washing technique is a primary intervention to prevent the spread of infections. Review measures to protect the child from infection.

44. Prednisone is given to children who are being treated for leukemia. Why is this medication given as part of the treatment plan? 1. Enhances protein metabolism. 2. Enhances sodium excretion. 3. Increases absorption of the chemotherapy. 4. Destroys abnormal lymphocytes.

44. 1. Prednisone does not enhance protein metabolism. 2. Prednisone may cause retention of sodium. 3. There is no drug that increases absorption of chemotherapy. 4. Prednisone is used in many of the treatment protocols for leukemia because there is abnormal lymphocyte production. Prednisone is thought to destroy abnormal lymphocytes. TEST-TAKING HINT: Prednisone is given in conjunction with chemotherapy. It helps modify the body's immune response.

45. Which of the following best describes the action of chemotherapeutic agents used in the treatment of cancer in children? Select all that apply. 1. Suppress the function of normal lymphocytes in the immune system. 2. Are alkylating agents and are cell-specific. 3. Cause a replication of DNA and are cell-specific. 4. Interrupt cell cycle, thereby causing cell death. 5. Prednisone is a natural hormone

45. 1, 4, 5. 1. All chemotherapy is immunosuppressive, because most childhood cancers affect the immune system. 2. Not all chemotherapy drugs are alkylating agents. 3. There is no replication of DNA with chemotherapy. Chemotherapy drugs such as the antimetabolites usually inhibit synthesis of DNA or RNA. 4. Mitotic inhibitors, such as vincristine (Oncovin), stop cell division but can also damage cells in all phases of the cell cycle. 5. The corticosteroids are natural hormones that can be used to prevent nausea and allergic reactions. They are given with other chemotherapeutic agents. TEST-TAKING HINT: Review the function of each type of chemotherapeutic agent. Chemotherapy targets cells at different phases of the cell life cycle.

47. A teen is seen in clinic for a possible diagnosis of Hodgkin disease. The nurse is aware that which of the following symptoms should make the health-care provider suspect Hodgkin disease? 1. Fever, fatigue, and pain in the joints. 2. Anorexia with weight loss. 3. Enlarged, painless, and movable lymph nodes in the cervical area. 4. Enlarged liver with jaundice.

47. 1. Fever and pain may be some of the symptoms, but they can be caused by other forms of cancer. Joint pain is not a symptom of Hodgkin disease. 2. Anorexia with weight loss can be a symptom of many other conditions. 3. Enlarged, painless, and movable lymph nodes in the cervical area are the most common presenting manifestations of Hodgkin disease. 4. Enlarged liver with jaundice is not a presenting symptom with Hodgkin disease. TEST-TAKING HINT: Review the clinical manifestations of Hodgkin disease. Some of the manifestations are the same for many different cancers, so focus on the primary and most common manifestations.

49. The parent of a teen with a diagnosis of Hodgkin disease asks what the child's prognosis will be with treatment. What information should the nurse give to the parent and child? 1. Clinical staging of Hodgkin disease will determine the treatment; long-term survival for all stages of Hodgkin disease is excellent. 2. There is a considerably better prognosis if the client is diagnosed early and is less than 5 years of age. 3. The prognosis for Hodgkin disease depends on the type of chemotherapy. 4. The only way to obtain a good prognosis is by chemotherapy and bone marrow transplant.

49. 1. Long-term survival for all stages of Hodgkin disease is excellent. Early-stage disease can have a survival rate greater than 90%, with advanced stages having rates between 65% and 75%. 2. Hodgkin disease mostly affects adolescents. 3. The treatment consists of chemotherapy and often radiation therapy and does not predict prognosis. 4. Bone marrow transplant is not always necessary with the treatment of Hodgkin disease and will most likely worsen the prognosis. TEST-TAKING HINT: Know the treatments for and the prognosis of Hodgkin disease.

52. The parent of a child diagnosed with Wilms tumor asks the nurse what the treatment plan will be. The nurse explains the usual protocol for this condition. Which information should the nurse give to the parent? 1. The child will have chemotherapy and, after that has been completed, radiation. 2. The child will need to have surgery to remove the tumor. 3. The child will go to surgery for removal of the tumor and the kidney and will then start chemotherapy. 4. The child will need radiation and later surgery to remove the tumor.

52. 1. Chemotherapy is started after tumor removal, and radiation is done depending on stage and histological pattern. 2. Combination therapy of surgery and chemotherapy is the therapeutic management. 3.Combination therapy of surgery and chemotherapy is the primary therapeutic management. Radiation is done depending on clinical stage and histological pattern. 4. Radiation should be done after surgery and chemotherapy, depending on stage and histological pattern. TEST-TAKING HINT: Staging and biopsy determine the treatment, but the child will always have the tumor and kidney removed, followed by chemotherapy.

56. Where is the primary site of origin of the tumor in children who have neuroblastoma? 1. Bone. 2. Kidney. 3. Abdomen. 4. Liver.

56. 1. Tumor involvement in the bone is usually osteosarcoma. 2. Tumors that are located in the kidney are most often a Wilms tumor. 3. Neuroblastoma tumors originate from embryonic neural crest cells that normally give rise to the adrenal medulla and the sympathetic nervous system. The majority of the tumors arise from the adrenal gland or from the retroperitoneal sympathetic chain. Therefore, the primary site is within the abdomen. 4. In most tumors in children, there is liver involvement when there is metastasis to the liver. TEST-TAKING HINT: Review the origin of neuroblastoma to determine the tumor sites.

7. Which of the following activities should a nurse suggest for a client diagnosed with hemophilia? Select all that apply. 1. Swimming. 2. Golf. 3. Hiking. 4. Fishing. 5. Soccer.

7. 1, 2, 3, 4. 1. Children with hemophilia should be encouraged to take part in noncontact activities that allow for social, psychological, and physical growth, such as swimming. 2. Children with hemophilia should be encouraged to take part in noncontact activities that allow for social, psychological, and physical growth, such as golf. 3. Children with hemophilia should be encouraged to take part in noncontact activities that allow for social, psychological, and physical growth, such as hiking. 4. Children with hemophilia should be encouraged to take part in noncontact activities that allow for social, psychological, and physical growth, such as fishing. 5. Contact sports like soccer should be discouraged. TEST-TAKING HINT: Soccer is the only contact sport listed, so the other answers can be selected.

8. Which of the following describes idiopathic thrombocytopenia purpura (ITP)? Select all that apply. 1. ITP is a congenital hematological disorder. 2. ITP causes excessive destruction of platelets. 3. Children with ITP have normal bone marrow. 4. Platelets are small in ITP. 5. Purpura is observed in ITP.

8. 2, 3, 5 1. ITP is an acquired hematological condition that is characterized by excessive destruction of platelets, purpura, and normal bone marrow along with an increase in large, yellow platelets. 2. ITP is characterized by excessive destruction of platelets. 3. The bone marrow is normal in children with ITP. 4. Platelets are large, not small. 5. ITP is characterized by purpura, which are areas of hemorrhage under the skin. TEST-TAKING HINT: Review the pathophysiology of ITP to determine the manifestations of the disease.

9. The nurse is caring for a child who is receiving a transfusion of PRBCs. The nurse is aware that if the child has a hemolytic reaction to the blood, the signs and symptoms would include which of the following? Select all that apply. 1. Fever. 2. Rash. 3. Oliguria. 4. Hypotension. 5. Chills.

9. 1, 3, 4. 1. Hemolytic reactions include fever, pain at insertion site, hypotension, renal failure, tachycardia, oliguria, and shock. 2. Febrile reactions are fever, rash, and chills. Allergic reactions include hives, itching, and respiratory distress. 3. Hemolytic reactions include fever, pain at insertion site, hypotension, renal failure, tachycardia, oliguria, and shock. 4. Hemolytic reactions include fever, pain at insertion site, hypotension, renal failure, tachycardia, oliguria, and shock. 5. Febrile reactions are fever, chills, and rash. Allergic reactions include rash, hives, and respiratory distress. TEST-TAKING HINT: Review the signs and symptoms of hemolytic reaction, febrile reaction, and allergic reaction. Understanding the causes of the reactions will help identify the symptoms.

30. definitive diagnosis of aplastic anemia

Bone marrow aspiration

Severe Combined Immunodeficiency (SCID)

Both limbs of lymphocyte system are missing or defective; no adaptive immune response

tumor lysis syndrome

Chemotherapy can cause massive term-32destruction of cells leading the creation of uric acid which can be toxic to the kidneys leading to Acute Tubular Necrosis. You can try to prevent this with hydration and allopurinol.

neutropenic precautions

Isolation procedures to protect an immunocompromised patient from infections

Diagnostic that confirms leukemia

Microscopic examination of bone marrow aspirate

Hodgkin vs Non-Hodgkin Lymphoma

NHL = no Reed Sternberg (RS) cells present, poor prognosis HL = RS cells present, good prognosis

Acute Lymphoblastic Leukemia (ALL)

This is the overproduction of immature lymphocytes. The lymphocytes divide rapidly but fail to mature. Lymphoblasts rise and crowd out normal WBCs, RBCs & platelets. The most common leukemia of childhood has highest incidence in Caucasian boys 3-4 years of age.

How is hemophilia inherited?

X-linked recessive

non-Hodgkin lymphoma (NHL)

any malignancy of B cells, T cells, or NK cells that does not involve Reed-Sternberg cells

intrathecal chemotherapy

delivery of chemotherapy drugs into the subarachnoid space by lumbar puncture

aplastic anemia

failure of blood cell production in the bone marrow

neuroblastoma

malignant tumor composed principally of cells resembling neuroblasts