Peds Chapter 27: The Child with a Condition of the Blood, Blood-Forming Organs, or Lymphatic System

On admission, a child with leukemia has widespread purpura and a platelet count of 19,000/mm3. What is the priority nursing intervention? a. Assessing neurological status

ANS: A When platelets are low, the greatest danger is spontaneous intracranial bleeding. Neurological assessments are therefore a priority of care.

What are the classic symptoms of thalassemia major (Cooley's anemia)? (Select all that apply.) a. Hepatomegaly b. Jaundice c. Protruding teeth d. Pathological fractures

ANS: A, B, C, D All of the options are classic signs of thalassemia major except renal failure.

A 6-year-old child with leukemia asks, "Who will take care of me in heaven?" What is the best response by the nurse? a. "Who do you think will take care of you?"

ANS: A This response gives the child an opportunity to verbalize his or her feelings and concerns, whereas closed responses shut off communication. The asking of a "why" question is not therapeutic as it calls for justification.

A 2-year-old child has been diagnosed with hemophilia A. What information should the nurse include in a teaching plan about home care? a. If bleeding occurs, apply pressure, ice, elevate, and rest the extremity.

ANS: A When bleeding occurs, the traditional approach is to follow RICE—rest, ice, compression, and elevation.

Which statement by a mother may indicate a cause for her 9-month-old's iron deficiency anemia? a. "Formula is so expensive. We switched to regular milk right away."

ANS: A Because cow's milk contains very little iron, infants should drink iron-fortified formula for the first year of life.

The nurse, caring for a child receiving chemotherapy, notes that the child's abdomen is firm and slightly distended. There is no record of a bowel movement for the last 2 days. What do these assessment findings suggest? a. Peripheral neuropathy

ANS: A Peripheral neuropathy may be signaled by severe constipation resulting from decreased nerve sensations in the bowel.

What should the nurse closely assess in a child receiving a transfusion? a. Fever

ANS: A The child receiving a blood transfusion is observed for signs of a transfusion reaction including chills, itching, fever, rash, headache, and back pain.

The most recent blood count for a child who received chemotherapy last week shows neutropenia. What is the priority nursing diagnosis for this child? a. Risk for infection

ANS: A The child with neutropenia is at risk for infection.

The nurse notes that a 4-year-old child's gums bleed easily and he has bruising and petechiae on his extremities. Which lab value is consistent with these symptoms? a. Platelet count of 25,000/mm3

ANS: A The normal platelet count is 150,000 to 400,000/mm3. This finding is very low, indicating an increased bleeding potential.

What should be included in the nursing care of a 12-year-old child receiving radiation therapy for Hodgkin's disease? (Select all that apply.) a. Application of sunblock b. Appetite stimulation c. Conservation of energy d. Provision for expressions of anger

ANS: A, B, C, D Sun block should be applied to skin after radiation to prevent burning. Low energy levels produce anorexia and anger in many young patients. Radiation delays the development of secondary sex characteristics and menses.

The nurse is caring for a child with a low platelet count. What skin assessments would alert the nurse to bleeding? (Select all that apply.) a. Petechiae b. Purpura c. Ecchymosis d. Hematoma

ANS: A, B, C, D The reduction or destruction of platelets in the body interferes with the clotting mechanism. Skin lesions that are common to these disorders include petechiae, a bluish, nonblanching, pinpoint-sized lesion; purpura, groups of adjoining petechiae; ecchymosis, an isolated bluish lesion larger than a petechia; and hematoma, a raised ecchymosis. Lymphadenopathy is an enlargement of lymph nodes that is indicative of infection or disease.

The family of a child receiving chemotherapy for leukemia should be taught to focus on which aspect(s) of the child's care? (Select all that apply.) a. Using a support group b. Stimulating appetite c. Maintaining adequate hydration e. Reporting exposure to infectious diseases

ANS: A, B, C, E Support groups are helpful for emotional support and realistic tips on care. The child on chemotherapy is anorexic and has no appetite. Maintenance of hydration is essential for the adequate therapeutic effect of the drugs. Because the drugs suppress the bone marrow, children are at risk for infection, and the suppression will not allow the antibody response needed for immunization.

Why would the nurse urge the family of a dying 12-year-old boy to include his 8-year-old sister in care? (Select all that apply.) a. She will feel less neglected by the parents. b. She can make amends for past hostilities to her brother. d. She can express her feelings through care. e. She can experience being supportive of her parents and brother.

ANS: A, B, D, E All options are potential benefits to including the sibling in the care of a dying child except increased helplessness. She would feel less helpless.

The nurse explains that the COPP medical regimen for the treatment of Hodgkin's disease uses a combination of which drugs? (Select all that apply.) a. Vincristine b. Cyclophosphamide d. Prednisone e. Procarbazine hydrochloride

ANS: A, B, D, E The COPP medical regimen includes the combination of cyclophosphamide, vincristine (Oncovin), prednisone, and procarbazine hydrochloride.

How has synthetic recombinant antihemophilic factor improved the management of hemophilia? (Select all that apply.) a. Eliminates the need for frequent transfusions. b. Can be administered by family at home. d. Reduces cost of care of the hemophiliac. e. Reduces risk of HIV and hepatitis A and B transmission.

ANS: A, B, D, E The drug can be given at home by the family. Because it supplies the missing factor, transfusions are not necessary and consequently the exposure to HIV and hepatitis A and B is reduced. Cost of care is greatly reduced because hospitalizations and transfusions are not as frequently required. The drug does not prevent hemorrhage; it makes hemorrhage manageable.

What would the nurse include in a teaching plan about mouth care of a child receiving chemotherapy? b. Clean teeth with a soft toothbrush.

ANS: B A soft toothbrush reduces capillary damage and mucous membrane breakdown and prevents bleeding and infection. Commercial mouthwashes may kill oral flora that combat infection. Water-Pik is useful for toughening gums.

What will the nurse teach the parents of a child with a low platelet count to avoid? b. Aspirin

ANS: B Aspirin interferes with platelet function and should be avoided to prevent the risk of prolonged bleeding.

The nurse is teaching the parents of a young child with iron deficiency anemia about nutrition. What food would the nurse emphasize as being a rich source of iron? b. Cream of Wheat

ANS: B Good nutritional sources of iron include boiled egg yolk, liver, green leafy vegetables, Cream of Wheat, dried fruits, beans, nuts, and whole-grain breads.

The nurse is presenting information on the congenital disorder of hemophilia A. What fact will the nurse include? b. It is transmitted by symptom-free females.

ANS: B Hemophilia A affects mostly males who received the sex-linked recessive trait from a symptom-free female. The defective gene is on the X chromosome.

Which statement made by a parent indicates an understanding of health maintenance of a child with sickle cell disease? b. "It is important for my child to drink plenty of fluids."

ANS: B Prevention of dehydration, which can trigger the sickling process, is a priority goal in the care of a child with sickle cell disease.

A child is diagnosed with iron deficiency anemia. What will the nurse explain can occur if this disorder goes untreated? b. Heart failure

ANS: B Untreated iron deficiency anemias progress slowly, and in severe cases the heart muscle becomes too weak to function. If this happens, heart failure follows.

What will the nurse administer with ferrous sulfate drops when providing them to a child on the pediatric unit? b. With orange juice

ANS: B Vitamin C aids in the absorption of iron, whereas food and milk interfere with the absorption of iron.

What important focus of nursing care for the dying child and the family should the nurse implement? c. Families should be made aware that hearing is the last sense to stop functioning before death.

ANS: C Hearing is intact even when there is a loss of consciousness.

An adolescent is diagnosed with Hodgkin's disease. Lymph nodes on both sides of her diaphragm have been found to be involved, including cervical and inguinal nodes. Which disease stage is this? c. III

ANS: C Lymph node regions on both sides of the diaphragm are consistent with a diagnosis of stage-III Hodgkin's disease.

The nurse is dealing with a preschool child with a life-threatening illness. What should the nurse remember the child's concept of death is at this age? c. That a person becomes alive again soon after death

ANS: C The preschooler views death as reversible and temporary.

A newly married couple is seeking genetic counseling because they are both carriers of the sickle cell trait. How can the nurse best explain the children's risk of inheriting this disease? c. Each child has a one in four chance of having the disease and a two in four chance of being a carrier.

ANS: C The sickle cell gene is inherited from both parents; therefore, each offspring has a one in four chance of inheriting the disease.

A 3-year-old child with sickle cell disease is admitted to the hospital in sickle cell crisis with severe abdominal pain. Which type of crisis is the child most likely experiencing? c. Vaso-occlusive

ANS: C Vaso-occlusive crisis, or painful crisis, is caused by obstruction of blood flow by sickle cells, infarctions, and some degrees of vasospasm.

A school-aged child is living with a chronic disease process. How would the nurse anticipate chronic illness will effect growth and development? (Select all that apply.) c. Impaired sense of belonging

ANS: C, D A school-age child is in the stage of industry versus inferiority. A chronic illness might experience loss of grade level in school because of illness and inability to participate or compete can lead to sense of inferiority. Sense of independence and accomplishment can be lost. Being different from peers may impede child's sense of belonging.

A child has just been diagnosed with acute lymphoblastic leukemia. What is the result of an overproduction of immature white blood cells in the bone marrow? d. Increased susceptibility to infection

ANS: D An overproduction of immature white blood cells increases the child's susceptibility to infection.

A child with thalassemia major receives blood transfusions frequently. What is a complication of repeated blood transfusions? d. Hemosiderosis

ANS: D As a result of repeated blood transfusions, excessive deposits of iron (hemosiderosis) are stored in tissues.

What is the result of a deficiency of factor IX? d. Christmas disease

ANS: D Christmas disease, or hemophilia B, is caused by the deficiency of factor IX.

The child receiving a transfusion complains of back pain and itching. What is the best initial action by the nurse? d. Clamp off blood and keep line open with normal saline.

ANS: D If a blood transfusion reaction occurs, the first action is to stop the blood infusion, keep the line open with normal saline, and notify the charge nurse.

The nurse finds an adolescent with Hodgkin's disease crying. The adolescent says, "I am so scared." What is the most appropriate nursing response to this c shouldn't feel that way." d. "Tell me what's got you scared."

ANS: D The nurse should encourage the adolescent to express her feelings and concerns.