Pediatrics: PrepU: Chapter 24
The nurse is explaining the procedure of bone marrow aspiration to a 6-year-old child with leukemia. What explanation would be best to give to the child?
"You may feel pressure on your hip during the procedure."
The nurse is assessing a 10-year-old girl with acute lymphoblastic leukemia. What information would lead the nurse to suspect that the cancer has infiltrated the central nervous system?
Child reports facial palsy and vision problems Explanation: The presence of facial palsy and vision problems indicates that the central nervous system has been infiltrated by leukemia cells. The petechiae, purpura, or unusual bruising result from decreased platelet levels and may be present regardless of metastasis. Adventitious breath sounds may indicate pneumonia and may be present whether the disease has metastasized or not. Hepatomegaly and splenomegaly result from infection, not metastasis.
When reviewing information about the incidence of the various types of childhood cancer, nursing students demonstrate understanding of the information when they identify which type as having the highest incidence?
Acute lymphoblastic leukemia (ALL)
Parents ask why their child just diagnosed with leukemia needs a "spinal tap." Which is the best response by the nurse?
"Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system."
The nurse is preparing to send a child with cancer for a radiation treatment. Which medication should the nurse provide to premedicate the child for this procedure?
Antiemetic Explanation: Radiation has systemic effects. Radiation sickness that includes nausea and vomiting is the most frequently encountered systemic effect. It also occurs to some extent as a result of the release of toxic substances from destroyed tumor cells. To counteract this, a child is prescribed an antiemetic before each procedure. The child does not need an analgesic, antipyretic, or antineoplastic agent prior to receiving a radiation treatment.
A group of nursing students are studying information about childhood cancers in preparation for a class examination. They are reviewing how childhood cancers differ from adult cancers. The group demonstrates understanding of the information when they identify what location as an unlikely site for childhood cancer?
Bladder Explanation: The most common sites for childhood cancer include the blood, lymph, brain, bone, kidney, and muscle. Bladder is a common site for adult cancer.
A high school football player has been diagnosed as having osteosarcoma of the femur. The parents are angry because they told their son not to play football. Which health teaching points would the nurse include in the teaching plan for the adolescent and his parents?
Football injuries do not contribute to the development of a tumor. Explanation: Osteosarcoma is the most malignant form of bone cancer. It is caused by the embryonic mesenchymal tissue that forms in the bones. A football injury may predispose more scrutiny of a lesion but it will not be the cause of the cancer, nor will the dislike of milk. Osteosarcoma may be treated with chemotherapy and radiation. It may also involve an amputation. The parents who state they are angry at their adolescent for playing football are more likely projecting their fears of the diagnosis and the future for their son.
A 15-year-old boy has been diagnosed with an osteogenic sarcoma of the distal femur. He also demonstrates a chronic cough, dyspnea, and chest pain, along with chronic leg pain. Based on these findings, the nurse should suspect metastasis to which body area?
Lungs
The nurse is evaluating the complete blood count of a 7-year-old child with a suspected hematological disorder. Which finding is associated with an elevated mean corpuscular volume (MCV)?
Macrocytic red blood cells (RBCs)
The nurse is caring for a child admitted to the hospital for an open fracture of the femur following a motor vehicle accident. The nurse notes the following lab values: white blood cells 10,000/mm3, hemoglobin 7.9 g/dl (79 g/L), hematocrit 28%, platelets 151,000/mm3. Which nursing action is priority?
Transfuse 1 unit of packed red blood cells. Explanation: In a situation where the child exhibits signs of anemia related to acute hemorrhage, the nurse should anticipate administering a transfusion of packed red blood cells to improve oxygenation and circulation. Administration of antibiotics, pain assessment, and family education can be performed after the beginning the blood transfusion.
A child with cancer has developed neutropenia and is in isolation with neutropenic precautions. What nursing assessment takes priority for this child?
infection symptoms
To prevent further sickle cell crisis, the nurse would advise the parents of a child with sickle cell anemia to:
notify a health care provider if the child develops an upper respiratory infection.
The pediatric nurse reviews the radiographs of a child and observes that there are lesions on the bone. The nurse interprets this finding as suggesting which condition?
Ewing sarcoma Explanation: Radiographs that show lesions on the bone may indicate tumors (e.g. Ewing sarcoma, osteosarcoma) or metastases of tumors warranting further investigation by bone scan, CT or MRI. Positron emission tomography is the most effective test to diagnose neuroblastoma, Hodgkin disease, Non-Hodgkin lymphoma, bone tumors, lung and colon cancers and brain tumors.
Which site is most frequently used to perform a bone marrow aspiration?
Iliac crest Explanation: The preferred site for bone marrow aspiration in children is the iliac crest. The other sites are not used for a bone marrow aspiration.
A child with hypoplastic anemia develops hemosiderosis. What nursing instruction promotes the treatment goals?
Infuse deferoxamine at home
The nurse is assessing a school-aged child with sickle-cell anemia. Which assessment finding is consistent with this child's diagnosis?
Slightly yellow sclera In sickle-cell anemia, eye scleras become icteric or yellowed from the release of bilirubin from the destruction of the sickled cells. Mandibular and long bone growth and depigmentation are not manifestations of this health problem.
The nurse develops a meal plan for a child with iron-deficiency anemia. Which meal would the nurse teach the parent has the highest amount of iron?
red meat, eggs, oatmeal, and dried fruit
After teaching the parents of a child diagnosed with pernicious anemia about the disorder and treatment, the nurse determines that the teaching was successful when the parents state:
"He'll need to have those vitamin shots for the rest of his life."
The school nurse is teaching a group of adolescents about cancer prevention using the Healthy People 2030 goals. What will the nurse teach these adolescents? Select all that apply.
"Human papillomavirus (HPV) vaccines are needed for both males and females to prevent cancer." "Do not give in to peer pressure to start smoking." "Use sunscreen any time you are out in the sun." "Decrease the use of fried foods in your diet."
Parents tell the nurse who is admitting their infant for a well-child exam that they recently saw a "white glow" in their child's left pupil. What is the nurse's best response?
"I will report this to the pediatrician."
The young boy has had his spleen surgically removed. Which statements by the boy's parents prior to discharge indicates that an adequate amount of learning has occurred?
"If he gets a fever, I'm going to call our physician right away." "Before he goes to the dentist, we'll make sure he gets antibiotics." "He's going to need several vaccines." "He's going to get really good at washing his hands."
A mother asks the nurse why her infant who was born at 34 weeks' gestation is being prescribed ferrous sulfate. Which response by the nurse is most appropriate?
"Preterm infants are at risk for iron-deficiency anemia." Explanation: Infants born prematurely are at risk for iron-deficiency anemia because iron stores are built during the last few weeks of gestation. Although some infants with pyloric stenosis may require an iron supplement, such as ferrous sulfate, not all infants will. Infants with excessive diarrhea may develop iron-deficiency anemia, and ferrous sulfate helps improve red blood cell formation, but this does not explain why a preterm infant is being prescribed an iron supplement.
rhabdomyosarcoma
"The tumor is in the muscle.
A child is to receive an oral corticosteroid as part of the treatment regimen for leukemia. After teaching the child and family about this drug, the nurse determines the need for additional teaching when they state:
"We should administer the drug on an empty stomach."
The toddler with a cancer diagnosis is seen for a well-child checkup. Which health maintenance activity will the nurse exclude?
Administering the measles, mumps, rubella (MMR) vaccine
The nurse is providing preoperative care for a 7-year-old boy with a brain tumor and his parents. Which intervention is priority?
Assessing the child's level of consciousness
A teenage girl asks why chemotherapy causes hair loss. Which response by the nurse is accurate?
Chemotherapy affects cancer cells and normal cells that multiply rapidly.
A child receiving chemotherapy is experiencing significant reduction in red blood cells secondary to myelosuppression. Which agent would the nurse most likely expect to be ordered?
Epoetin alfa
The nurse identifies the nursing diagnosis of Risk for infection related to chemotherapy-induced immunosuppression. What would the nurse include in the teaching plan for the child and parents about reducing the child's risk? Select all that apply.
Having the child sleep in a single bed and room Encouraging frequent, thorough handwashing
When caring for a 7-year-old client diagnosed with sickle cell anemia, which clinical manifestation will the nurse report to the health care provider first?
Hyperactive bowel sounds
The child with thalassemia may be given which classification of medication to prevent one of the complications frequently seen with the treatment of this disorder?
Iron-chelating drugs Frequent transfusions can lead to complications and additional concerns for the child, including the possibility of iron overload. For these children, iron-chelating drugs such as deferoxamine mesylate may be given. Vitamin and potassium supplements would not be given to treat the iron overload. Factor VIII preparations are given to the child with hemophilia.
What is a well-defined risk management technique that the nurse can teach children and parents to prevent cancer?
Limit sun exposure throughout childhood and adolescence
When providing care for a child immediately after a bone marrow aspiration, which nursing action is priority?
Monitor the site dressing and vital signs.
A group of nursing students are reviewing the process of blood cell formation. The students demonstrate understanding of this process when they place the formation events in their proper sequence. What is the proper sequence?
Multipotent stem cell Myeloid progenitor Megakaryocyte/erythroid progenitor Megakaryocyte Platelets
A child diagnosed with hemophilia presents with warm, swollen, painful joints. Which action will the nurse take first?
Prepare to administer factor replacement medication
A 5-year-old client has been diagnosed with leukemia and is currently on chemotherapy and radiation. The child is having difficulty due to mucositis. Which is the most appropriate nursing diagnosis for this child?
Risk for imbalanced nutrition, less than body requirements, related to inflammation
When developing the postoperative plan of care for a child with sickle cell anemia who has undergone a splenectomy, which would the nurse identify as the priority?
Risk for infection
The nurse is talking with a 9-year-old child diagnosed with acute leukemia who will soon begin chemotherapy. The child expresses worry that when her hair falls out friends won't like her or want to play with her anymore. Which response by the nurse would be best?
Talk with her and her family about wearing a wig, cap, or scarf.
After teaching a group of students about hemophilia, the instructor determines that the students have understood the information when they identify hemophilia A as involving a problem with:
factor VIII. Explanation: In hemophilia A, the problem is with factor VIII, and in hemophilia B the problem lies with factor IX. Platelets are problematic in idiopathic thrombocytopenic purpura (ITP). Plasmin is involved in the pathophysiologic events of disseminated intravascular coagulation.
The nurse is providing care for a 13-year-old child diagnosed with iron-deficiency anemia. The client's current hemoglobin level is 11 g/dL (110 g/L). Which intervention will the nurse anticipate including in the client's care?
giving ferrous sulfate with orange juice between meals
The nurse is administering meperidine as ordered for pain management for a 10-year-old boy in sickle cell crisis. The nurse would be alert for:
seizures.
Parents ask why their child just diagnosed with leukemia needs a "spinal tap." Which is the best response by the nurse?
"Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system.
A 4-year-old child diagnosed with Wilms tumor is admitted for surgery. What information would be most important for the nurse to include in the child's preoperative plan of care?
Avoiding further abdominal palpation
What is one advantage of an implanted port (central venous access device) that the nurse will explain to an adolescent?
Body appearance changes very little.
A nurse is providing care to a child with hemophilia who is experiencing muscle and joint involvement related to the bleeding. Which would the nurse include as an adjunctive measure to control bleeding?
Compression
A toddler who is beginning to walk has fallen and hit his head on the corner of a low table. The caregiver has been unable to stop the bleeding and brings the child to the pediatric clinic. The nurse is gathering data during the admission process and notes several bruises and swollen joints. A diagnosis of hemophilia is confirmed. This child most likely has a deficiency of which blood factor?
Factor VIII
The nurse is assessing a 3-year-old boy whose mother reports that he is listless and has been having trouble swallowing. Which finding suggests the child may have a brain tumor?
Observation reveals nystagmus and head tilt Explanation: Coupled with the mother's reports, observation of nystagmus and head tilt suggest the child may have a brain tumor. Elevated blood pressure of 120/80 mm Hg may be indicative of Wilms tumor. F ever and headaches are common symptoms of acute lymphoblastic leukemia. A cough and labored breathing points to rhabdomyosarcoma near the child's airway.
The nurse is reviewing the medical record of a child diagnosed with Hodgkin's lymphoma. Which would the nurse identify as typically the first sign reported by the child?
Painless, enlarged lymph node
A child diagnosed with hemophilia presents with warm, swollen, painful joints. Which action will the nurse take first?
Prepare to administer factor replacement medication Explanation: Many clients with hemophilia have repeated episodes of hemarthrosis or bleeding into the joints, and develop functional impairment of the joints, despite careful treatment. To assist in limiting impairment, the nurse would prepare to administer factor replacement medications, such as plasma, recombinant clotting factor VIII, or a clotting promotor medication. The nurse would document the finding, notify the health care provider, and assess the client for additional symptoms after limiting the amount of blood loss.
The nurse is assessing a school-aged child with sickle-cell anemia. Which assessment finding is consistent with this child's diagnosis?
Slightly yellow sclera
The nurse is examining the hands of a child with suspected iron deficiency anemia. Which finding should the nurse expect?
Spooning of nails Explanation: A convex shape of the fingernails termed 'spooning' can occur with iron deficiency anemia. Capillary refill in less than 2 seconds, pink palms and nail beds, and absence of bruising are normal findings.
A child with cancer is dying and in hospice care. When developing the plan of care, which intervention should the nurse include as the primary focus?
keeping the child pain-free
A child with cancer is to start chemotherapy. The nurse wishes to assess the psychosocial status of the child and the family. Which therapeutic communication technique would be best for the nurse to use?
using broad openings Explanation: During therapy for cancer it is important to assess and evaluate the child's and family's psychosocial status. Many factors impact this status: fear of dying, economic impact, child's isolation from friends and school, etc. When completing an assessment it is important for the nurse to use therapeutic communication techniques. The best option is to use broad openings by using open-ended questions. This opens up the discussion and prevents yes-or-no answers. These types of questions allow the child or parents to take the lead in the interaction. Giving reassurance is a nontherapeutic technique. Reassuring will indicate that there is not any reason for the child or family to be anxious. Giving recognition is a therapeutic technique. Giving recognition indicates to the child and family the nurse is aware they have stress but it doe not assess their feelings. Encouraging expression is a therapeutic technique, but it is useful only in asking the child and family to look at their current situation, not explore their feelings about them.
The nurse caring for a 14-year-old scheduled for magnetic resonance imaging (MRI) explains to a family how the test works. Which response accurately describes this test?
"The MRI uses radio waves and magnets to produce a computerized image of the body." Explanation: The MRI uses radio waves and magnets to produce a computerized image of the body. The bone scan is a nuclear scanning test to rule out cancer involving the bones or determine extent of bone involvement. The ultrasound uses sound waves to create images that visualize body structures and locate masses. Radiography uses radiation to examine soft tissue and bony structures of the body.
idiopathic thrombocytopenic purpura
Risk for bleeding related to insufficient platelet formation Explanation: Idiopathic thrombocytopenic purpura is the result of a decrease in the number of circulating platelets in the presence of adequate megakaryocytes, which are precursors to platelets. Because bleeding can occur with this disease process, the diagnosis most appropriate for the client at this time is risk for bleeding related to insufficient platelet formation. Reduced numbers of platelets would not increase the client's risk for infection. Reduced numbers of platelets does not increase the client's risk for renal impairment. Reduced risk of platelets will not lead to an ineffective breathing pattern.
The parents of a 6-year-old child with idiopathic thrombocytopenic purpura (ITP) ask the nurse conducting an assessment of the child what causes the disease. What is the nurse's best response?
"ITP is primarily an autoimmune disease in which the immune system attacks and destroys the body's own platelets, for an unknown reason." Idiopathic thrombocytopenic purpura (ITP) is primarily an autoimmune disease, which is an acquired, self-limiting disorder of hemostasis characterized by destruction and decreased numbers of circulating platelets. The child will exhibit symptoms of excessive petechiae, purpura, and bruising. Hemophilia A and hemophilia B are distinguished by the particular procoagulant factor that is decreased, absent, or dysfunctional. Iron-deficiency anemia occurs when the body's iron stores are depleted. Hereditary spherocytosis (HS) is characterized by loss of surface area on the red blood cell membrane.
A nurse is providing care to a child who is to receive a blood transfusion. The health care provider has prescribed the infusion to run at a rate of 5 ml/kg/hour. The child weighs 55 lb (25 kg). At what rate should the nurse set the infusion pump? Record your answer using a whole number.
125 Explanation: The nurse will use the child's weight in kilograms, and multiply weight by the prescribed milligrams per hour. 25 kg × 5 ml = 125 ml/hour