Peds Final

The nurse is teaching the parents of a 4-year-old boy with a peanut allergy about diet and possible unexpected locations of peanuts or peanut oil in food products. After describing this to the parents, which response by the mother would indicate a need for further teaching? a) "We can't go wrong with hamburgers and hot dogs." b) "We must be careful with Asian food." c) "We must be careful about baked goods." d) "Some hot-chocolate mixes have peanuts."

"We can't go wrong with hamburgers and hot dogs."

A school-aged child has a bee-sting allergy. When the child is stung by a bee during a school recess, assuming that all of the following interventions are covered by school protocol, which initial intervention by the school nurse would be most appropriate? a) Immediately transport the child to the local hospital. b) Apply a warm compress to the site of the bee sting. c) Administer epinephrine immediately. d) Notify the child's mother.

Administer epinephrine immediately.

Parents ask why their child just diagnosed with leukemia needs a "spinal tap." Which is the best response by the nurse? a) "Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system." b) "The spinal tap will help relieve pressure and headache for your child." c) "It will help rule out a second malignancy." d) "A sample of cerebrospinal fluid is needed to check for possible central nervous system infection."

Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system." Correct Explanation: The cerebrospinal fluid is checked so the clinician can determine whether leukemic cells have invaded the central nervous system. It is common for a chemotherapy medication, usually methotrexate, to be administered immediately following lumbar puncture as treatment for potential infiltration. The other responses are incorrect.

The nurse is assessing a 10-year-old girl with acute lymphoblastic leukemia. Which of the following would lead the nurse to suspect that the cancer has infiltrated the central nervous system? a) Observing petechiae, purpura, or unusual bruising b) Child complains of facial palsy and vision problems c) Noting adventitious breath sounds during auscultation d) Palpation of abdomen reveals enlarged liver and spleen

Child complains of facial palsy and vision problems Correct 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 results 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.

A child with systemic lupus erythematosus is receiving hydroxychloroquine sulfate. Which instruction would the nurse emphasize when teaching the child and parents about this drug? a) Importance of yearly eye examinations b) Avoiding grapefruit juice when taking the drug c) Giving with foods to minimize gastrointestinal upset d) Need to gradually taper the drug dosage over time

Importance of yearly eye examinations

A child with ALL is beginning treatment with methotrexate in an attempt to eradicate the leukemic cells. The stage of therapy represents which of the following? a) Delayed intensive-therapy phase b) Induction phase c) Consolidation phase d) Sanctuary phase

Induction phase Correct Explanation: An induction phase is the first attempt at eradicating the leukemic cells to induce or achieve a complete remission.

Which behavior typical of children with autism spectrum disorder (ASD) requires you to maintain special care to keep them safe? a) A fascination with bright colors b) A craving for salt c) Insensitivity to pain d) Loss of hearing for high frequencies

Insensitivity to pain

The nurse is caring for a child with systemic lupus erythematosus. The doctor will most likely order which test to monitor the child's progress? a) IgG subclasses b) Immunoglobulin electrophoresis c) Lymphocyte immunophenotyping T-cell quantification d) Complement assay (C3 and C4)

Lymphocyte immunophenotyping T-cell quantificationall

he nurse is caring for a 10-year-old recently diagnosed with attention deficit/hyperactivity disorder (ADHD). The nurse would expect to provide teaching regarding which medication? a) Trazodone b) Methylphenidate c) Buspirone d) Fluoxetine

Methylphenidate

The nurse is caring for a 6-year-old girl with leukemia who is having an oncological emergency. Which of the following signs and symptoms would indicate hyperleukocytosis? a) Wheezing and diminished breath sounds b) Tachycardia and respiratory distress c) Respiratory distress and poor perfusion d) Bradycardia and distinct S1 and S2 sounds

Tachycardia and respiratory distress Explanation: Increased heart rate, murmur, and respiratory distress are symptoms of hyperleukocytosis (high white blood cell count) which is associated with leukemia. Increased heart rate and blood pressure are indicative of tumor lysis syndrome, which may occur with acute lymphoblastic leukemia, lymphoma, and neuroblastoma. Wheezing and diminished breath sounds are signs of superior vena cava syndrome related to non-Hodgkin's lymphoma or neuroblastoma. Respiratory distress and poor perfusion are symptoms of massive hepatomegaly which is caused by a neuroblastoma filling a large portion of the abdominal cavity.

The nurse is collecting data on an 18-month-old old child with a diagnosis of autism spectrum disorder (ASD). Which of the following clinical manifestations would likely have been noted in the child with this diagnosis? a) The child cries and runs to the door when the caregiver leaves the room. b) The child sits quietly in the caregivers lap during interview. c) The child smiles when the caregiver shows her a stuffed animal. d) The child does not make eye contact.

The child does not make eye contact.

To feed lunch to a child with autism spectrum disorder (ASD), which of the following actions would be most important to take? a) Use a repetitive series of movements. b) Use an authoritarian manner to gain control. c) Allow the child to ask questions about the procedure. d) Don't allow him to see the spoon approach his mouth

Use a repetitive series of movements.

The characteristics of the child with autism fall into three categories. Which of the following are the three categories that these characteristics fall in to? a) Inability to respond to verbal stimuli b) Decreased ability to meet developmental milestones c) Inability to communicate with others d) Obviously limited activities and interests. e) Inability to relate to others

• Inability to relate to others • Inability to communicate with others • Obviously limited activities and interests.

The nurse is caring for a 6-year-old boy with an abdominal neuroblastoma prior to having a magnetic resonance imaging (MRI) scan without contrast done. Which of the following interventions would the nurse expect to perform? a) Encouraging fluid intake to increase radionuclide uptake b) Administering a sedative as ordered to keep the child still c) Applying EMLA to the injection site prior to inserting the IV d) Advising the physician that the child is allergic to shellfish

Administering a sedative as ordered to keep the child still

The nurse in the well-child clinic observes that a 5-year-old child in the waiting room is having trouble using a crayon to color. During the visit, the same child climbs off the table several times even after the nurse has asked him to stay on the table. Each time the nurse reminds him he says, "Oh, yeah," and happily climbs back up. The nurse suspects that which of the following applies to this child? a) The child has autism spectrum disorder. b) The child has failure to thrive. c) The child has an addicted caregiver. d) The child has attention deficit hyperactive disorder (ADHD).

The child has attention deficit hyperactive disorder (ADHD).

When explaining the procedure of bone marrow aspiration to a child with leukemia, what would be the best explanation? a) "You will have to lie on your back and hold your breath." b) "You won't feel any pain at all, because you will be asleep." c) "You will feel pressure on your hip from the needle." d) "You will need to lie still afterward to prevent a headache."

"You will feel pressure on your hip from the needle." Correct Explanation: Bone marrow aspiration requires hard pressure to allow the needle to puncture the bone. It is usually done under local anesthesia or conscious sedation.

Which of the following treatments are common to both systemic lupus erythematosus and juvenile idiopathic arthritis? Select all that apply. a) Antipyretics b) Corticosteroids c) Antirheumatics d) Nonsteroidal antiinflammatories e) Antimalarials

• Corticosteroids • Nonsteroidal antiinflammatories

What is the best response by the nurse to the parents of a child with leukemia who express guilt because they did not take immediate action when their child seemed to develop one respiratory infection after another? a) "Young children develop minor illness easily and often. Stop being hard on yourselves." b) "Don't feel bad. Children get lots of colds." c) "Keep in mind that the signs of leukemia are often subtle and difficult to recognize." d) "You need to focus on the present treatment now and not worry about the past."

"Keep in mind that the signs of leukemia are often subtle and difficult to recognize." Correct Explanation: Pointing out that the signs and symptoms of leukemia are often difficult to recognize indicates to the parents that they were not neglectful, while also providing information about the disease. The other responses minimize the parents' feelings or tell them how they should feel and are not therapeutic.

A 9-year-old child with leukemia is scheduled to undergo an allogenic hematopoietic stem cell transplant. When teaching the child and parents, which of the following would the nurse include? a) "The risk for rejection is much less with this type of transplant." b) "You'll need to have an incision in your hip area to instill the cells." c) "We'll need to have a match to a donor." d) "You won't need to receive the high doses of chemotherapy before the transplant."

"We'll need to have a match to a donor." Correct Explanation: An allogenic hematopoietic stem cell transplantation (HSCT) refers to transplantation using stem cells from another individual that are harvested from the bone marrow, peripheral blood, or umbilical cord blood. With this type of transplant, human leukocyte antibody (HLA) matching must occur. Therefore, the lesser the degree of HLA matching in the donor, the higher the risk for graft rejection and graft-versus-host disease (GVHD). Regardless of the type of transplant, a period of purging of abnormal cells in the child is necessary and accomplished through high-dose chemotherapy or irradiation. The procedure is accomplished by intravenously infusing hematopoietic stem cells into the child.

The nurse is teaching the parents of a 15-year-old boy who is being treated for acute myelogenous leukemia about the side effects of chemotherapy. For which of the following symptoms should the parents seek medical care immediately? a) Difficulty or pain when swallowing b) A temperature of 101°F (38.3° C) or greater

A temperature of 101°F (38.3° C) or greater

When reviewing information about the incidence of the various types of childhood cancer, nursing students demonstrate understanding of the information when they identify which of the following as having the highest incidence? a) Acute lymphocytic (lymphoblastic) leukemia b) Osteogenic sarcoma c) Neuroblastoma d) Non-Hodgkin's lymphoma

Acute lymphocytic (lymphoblastic) leukemia Correct Explanation: Acute lymphocytic leukemia accounts for approximately 32% of all childhood cancers. Neuroblastomas account for 8%; non-Hodgkin's lymphoma accounts for 6%; osteogenic sarcoma accounts for 3%

The nurse is discussing food allergies with parents of a young child. She explains that a very effective way to determine which foods a child may be allergic to is to implement a) A raw food diet b) Allergy skin testing c) A food diary d) An elimination diet

An elimination diet

A child with ADHD is placed on methylphenidate (Ritalin) therapy. Which of the following symptoms may children on Ritalin develop? a) Rapid increase in height b) Hypotension c) Sleepiness d) Anorexia

Anorexia

When treating allergies in a child, the nurse is aware that the classification for the drug of choice to control itching, sneezing, and rhinorrhea is which of the following? a) Antihistamines b) Decongestants c) Corticosteroids d) Antibiotics

Antihistamines

The parents of a child with juvenile idiopathic arthritis bring the child to the emergency department because the child is very drowsy and breathing heavily. The child also has been vomiting and complaining of ringing in her ears. The nurse suspects that the child is experiencing a toxic reaction to one of her medications. Which medication would the nurse suspect? a) Aspirin b) Corticosteroid c) Etanercept d) Methotrexate

Aspirin

A nurse is assisting with skin testing for allergies in a 14-year-old girl. Which of the following should the nurse do to ensure an accurate test? a) Be certain that the child has not received an antihistamine in the past 8 hours b) Read the test results within 40 minutes of administration c) Apply a local anesthetic to the testing site, as the injections are painful d) Inject the allergens into the muscle of the child's forearm

Be certain that the child has not received an antihistamine in the past 8 hours

The nurse is admitting to an examination room a child with the diagnosis of "probable acute lymphoblastic leukemia." What will confirm this diagnosis? a) History of leukemia in twin b) Lethargy, bruising, and pallor c) Bone marrow aspiration d) Complete white blood count

Bone marrow aspiration Correct Explanation: Bone marrow aspiration and biopsy are diagnostic. An abnormal white blood count and symptoms of lethargy, bruising, and pallor only create suspicion of leukemia; a twin may or may not be affected.

The nurse is preparing a discharge teaching plan for the parents of an 8-year-old girl with leukemia. Which instruction would be the priority? a) Calling the doctor if the child gets a sore throat b) Keeping a written copy of the treatment plan c) Writing down phone numbers and appointments d) Using acetaminophen if the child needs an analgesic

Calling the doctor if the child gets a sore throat

Food allergies have become more and more common in the last few decades. Which of the following are common food allergies of childhood? Select all that apply. a) Cheerios b) Apples c) Milk d) Peanuts e) Eggs

Eggs • Peanuts • Milk

The nurse is caring for a 4-year-old boy following surgical removal of a stage I neuroblastoma. Which of the following interventions will be most appropriate for this child? a) Applying aloe vera lotion to irradiated areas of skin b) Giving medications as ordered via least invasive route c) Maintaining isolation as prescribed to avoid infection d) Administering antiemetics as prescribed for nausea

Giving medications as ordered via least invasive route

The nurse instructs a school-aged child who has a bee-sting allergy and his parents on proper use of the EpiPen. What is the order of steps that should be taken if the child is bit by a bee? Remove gray safety cap. Place EpiPen against child's thigh, injecting solution. Grasp the EpiPen with your fist, with black tip pointing down. Hold syringe in place for 10 seconds.

Grasp the EpiPen with your fist, with black tip pointing down. Remove gray safety cap. Place EpiPen against child's thigh, injecting solution. Hold syringe in place for 10 seconds.

What advice would be most appropriate for the child with a stinging-insect allergy? a) Arrange for allergy testing for foods with ingredients similar to those in insect venom. b) Obtain a Medic-Alert bracelet so the presence of the allergy can be identified easily. c) Join a peer support group to help relieve anxiety about this problem. d) Consult a genetic counselor to reveal other susceptible family members.

Obtain a Medic-Alert bracelet so the presence of the allergy can be identified easily.

Which of the following signs is consistent with autism spectrum disorder (ASD)in a 2-year-old boy? a) Has below-average intellectual function b) Performs repetitive activity with toys c) Possesses excellent language development d) Shows signs of losing attained skills

Performs repetitive activity with toys

A child with ALL is receiving methotrexate for therapy. Which nursing diagnosis below would best apply to him during therapy? a) Excess fluid volume related to effect of methotrexate on aldosterone secretion b) Risk for impaired skin integrity related to oral ulcerations associated with chemotherapy c) Risk for impaired mobility related to depressant effects of methotrexate d) Risk for self-directed violence related to effect of methotrexate on central nervous system

Risk for impaired skin integrity related to oral ulcerations associated with chemotherapy

Which of the following signs and symptoms suggest that a 5-year-old boy who does not maintain eye contact or speak may have autism spectrum disorder (ASD)? a) The child has a long face and prominent jaw. b) The child has a slight decrease in head circumference. c) The child constantly pats his legs. d) The child is highly active and inattentive.

The child constantly pats his legs.

To establish whether the problem is truly a milk allergy in a child who is suspected of having this condition, milk should be reintroduced every 6 to 12 months. a) True b) False

True

The nurse is observing a group of 2- and 3-year-olds in a play group. Which behavior noted in one of the children indicates to the nurse that the child may have autism spectrum disorder (ASD)? a) While the other children are eating a snack, the child walks around the room feeling the walls and ignores the caregiver who offers him a snack. b) A child flips the light switch off and on until the caregiver asks her to stop and join the other children in playing. c) A child playing in the kitchen area pretends to pour a glass of milk and repeats this over and over. d) After another child takes a toy, the child cries and stomps his feet.

While the other children are eating a snack, the child walks around the room feeling the walls and ignores the caregiver who offers him a snack.

The 18-month-old toddler has been brought into the pediatrician's office by his parents. The nurse interviews the parents regarding the child's abilities. Which findings are warning signs that the toddler may have autism spectrum disorder? Select all that apply. a) Cannot stand on tiptoe b) Has never "babbled" c) Does not use any words d) Does not speak in short sentences e) Does not exhibit attempts to communicate by pointing to objects

• Has never "babbled" • Does not exhibit attempts to communicate by pointing to objects • Does not use any words

Children with ALL may need periodic lumbar punctures. You would teach the mother this is done to assess for a) early meningitis. b) leukemic cells. c) platelets. d) early development of septicemia

leukemic cells. Correct Explanation: Leukemic cells in cerebrospinal fluid must be identified because, if present, they require additional therapy.

he nurse is caring for a child with ADHD. Which behavior would the nurse not expect the child to display: 1. moody, morose behavior with pouting 2. interruption and inability to take turns 3. forgetfulness and easy distractibility 4. excessive motor activities and fidgeting

moody, morose behavior with pouting

Parents bring their daughter to the health care facility for evaluation. They report that lately the child seems rather pale and really tired. Which of the following would the nurse most likely find with further assessment if the child has acute lymphocytic leukemia? Select all that apply. a) Painless cervical lymphadenopathy b) Headache c) Low-grade fever d) Chest pain e) Bleeding from the oral mucous membranes

• Bleeding from the oral mucous membranes • Headache • Painless cervical lymphadenopathy • Low-grade fever

A nurse is preparing a presentation for a group of new parents and is planning to discuss nutrition during the first year. As part of the presentation, the nurse is planning to address foods that should be avoided to reduce the risk of possible food allergies. Which of the following would the nurse most likely include? Select all that apply. a) Peanuts b) Shrimp c) Eggs d) Carrots e) Oranges f) Potatoes

• Peanuts • Shrimp • Eggs

A child is diagnosed with a latex allergy. When developing the teaching plan for this child, the nurse would include which of the following foods to avoid? Select all that apply. a) Bananas b) Squash c) Peanut butter d) Cheese e) Cherries f) Pineapples

• Pineapples • Cherries • Bananas

The mother of a child with a possible food allergy asks the nurse for information about how to test for it. Which response by the nurse would be most appropriate? a) "Skin testing using a patch is probably the easiest method." b) "The best way is to eliminate the food from the diet and then look for improvement." c) "We can inject an extract of the food under the skin and see if there is a reaction." d) "We can check the level of antibodies in the blood to confirm the allergy."

"The best way is to eliminate the food from the diet and then look for improvement."

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 which of the following? a) "We should administer the drug on an empty stomach." b) "We will need to gradually decrease the dosage." c) "We should check our son's urine for glucose." d) "He might develop a rounded face from this drug."

"We should administer the drug on an empty stomach." Correct Explanation: Corticosteroids are commonly administered with food to decrease the risk for gastrointestinal upset. Corticosteroids can disrupt glucose balance, so urine should be checked for glucose. A moon face is an adverse effect of corticosteroids. Corticosteroids need to be tapered gradually to reduce the risk of adrenal insufficiency.

The mother of a 10-year-old boy with attention deficit hyperactivity disorder (ADHD) contacts the school nurse. She is upset because her son has been made to feel different by his peers because he has to visit the nurse's office for a lunch time dose of medication. The boy is threatening to stop taking his medication. How should the nurse respond? a) "He will need to learn to ignore the children, he needs this medication." b) "You may want to talk to your physician about an extended release medication." c) "I can have the teacher speak with the other children." d) "Remind him that his schoolwork may deteriorate."

"You may want to talk to your physician about an extended release medication."

The nurse caring for a patient with leukemia documents the following signs that are clinical or diagnostic features of the disease (select all answers that apply): a) Lymphadenopathy b) Bruising c) Sore throat d) Increased hemoglobin e) Anorexia f) Increased platelet count

Bruising • Anorexia • Sore throat • Lymphadenopathy Explanation: Clinical and diagnostic features of leukemia include fatigue, weakness, pallor, fever, bruising, bleeding (e.g., petechiae or purpura), weight loss, anorexia, swollen gums, sore throat, recurrent infections, flu-like symptoms, abdominal pain, nausea, vomiting, bone pain, lymphadenopathy, splenomegaly, hepatosplenomegaly, elevated leukocyte count (mm3), decreased hemoglobin (g/dL), and decreased platelets.

The nurse is assessing an 11-year-old girl diagnosed with acute myelogenous leukemia (AML) who came to the emergency department. Which of the following would alert the nurse to the need for immediate intervention? a) CBC indicates hyperleukocytosis. b) Palpation reveals lymphadenopathy in the axillae. c) Observation discloses weight loss and muscle wasting. d) Child complains of headache and vision problems.

CBC indicates hyperleukocytosis. Explanation: About 25% of children with acute myelogenous leukemia present with blood counts greater than 100,000. This is called hyperleukocytosis, and it is a medical emergency requiring leukapheresis to decrease hyperviscosity by quickly decreasing the number of circulating blasts. Lymphadenopathy, headache, visual disturbance, weight loss, and muscle wasting are signs and symptoms common to both types of leukemia. Lymphadenopathy is a common manifestation associated with AML and does not require immediate intervention. Headache and vision problems are common manifestations associated with AML. They do not require immediate intervention. Weight loss and muscle wasting are common manifestations associated with AML. They do not require immediate intervention.

The child has been diagnosed with leukemia. Rank the following medications used to treat leukemia in order based on the stage of treatment. The child is receiving chemotherapy through an intrathecal catheter. The child is receiving vincristine through an intravenous line and oral steroids. The child is receiving low doses of mercaptopurine and methotrexate. The child is receiving high doses of mercaptopurine and methotrexate.

The child is receiving vincristine through an intravenous line and oral steroids. The child is receiving high doses of mercaptopurine and methotrexate. The child is receiving low doses of mercaptopurine and methotrexate. The child is receiving chemotherapy through an intrathecal catheter. Explanation: During induction, the child receives oral steroids and IV vincristine. During consolidation, the child receives high doses of methotrexate and mercaptopurine. During maintenance, the child receives low doses of methotrexate and mercaptopurine. During central nervous system prophylaxis, the child receives intrathecal chemotherapy.