Peds Final Exam

What is an appropriate nursing action before surgery when caring for a child diagnosed with a Wilms' tumor?

DO NOT PALPATE ABD

One of the clinical manifestations of chronic renal failure is uremic frost. Which best describes this term?

Deposits of urea crystals on skin

Which is a common clinical manifestation of Hodgkin disease?

Enlarged, firm, nontender lymph nodes

Which is the most appropriate nursing diagnosis for the child with acute glomerulonephritis?

Fluid Volume Excess related to decreased plasma filtration

An adolescent will receive a bone marrow transplant (BMT). The nurse should explain that the bone marrow will be administered by which route?

IV infusion

The nurse is conducting a staff in-service on sickle cell anemia. Which describes the pathologic changes of sickle cell anemia?

Increased red blood cell destruction occurs.

Which clinical manifestation should the nurse expect when a child with sickle cell anemia experiences an acute vasoocclusive crisis?

Painful swelling of hands and feet; painful joints

The nurse is admitting a newborn with hypospadias to the nursery. The nurse expects which finding in this newborn?

The urethral opening is along the ventral surface of the penis.

When an adolescent with a new diagnosis of Ewing sarcoma asks the nurse about treatment, the nurse's response is based on the knowledge that

This type of tumor invades the bone. Management includes chemotherapy, surgery, and radiation. Affected bones such as ribs and proximal fibula may be removed to excise the tumor.

Which is included in the diet of a child with minimal change nephrotic syndrome?

salt restriction

Which is the most common cause of acute renal failure in children?

severe dehydration

A child with a brain tumor is undergoing radiation therapy. What should the nurse include in the discharge instructions to the child's parents?

Avoid excessive skin exposure to the sun. Plan for adequate rest periods for the child. A darkening of the skin receiving radiation is expected.

What is a priority nursing diagnosis for the 4-year-old child newly diagnosed with leukemia?

Risk for Infection related to immunosuppressed state

The nurse is caring for an adolescent who has just started dialysis. The child seems always angry, hostile, or depressed. The nurse should recognize that this is most likely related to:

adolescents often resenting the control and enforced dependence imposed by dialysis.

A young boy will receive a bone marrow transplant (BMT). This is possible because one of his older siblings is a histocompatible donor. Which is this type of BMT called?

allogenic

A school-age child is admitted to the hospital with acute glomerulonephritis and oliguria. Which dietary menu items should be allowed for this child?

apples carrot sticks strawberries

A child with acute myeloblastic leukemia is scheduled to have a bone marrow transplant (BMT). The donor is the child's own umbilical cord blood that had been previously harvested and banked. This type of BMT is termed

autologous

Parents of a school-age child with hemophilia ask the nurse, "Which sports are recommended for children with hemophilia?" Which sports should the nurse recommend?

b. Swimming d. Golf e. Bowling

A boy with leukemia screams whenever he needs to be turned or moved. Which is the most probable cause of this pain?

bone involvement

The nurse understands that the type of precautions needed for children receiving chemotherapy is based on which actions of chemotherapeutic agents?

bone marrow

A nurse determines that parents understood the teaching from the pediatric oncologist if the parents indicate that which test confirms the diagnosis of leukemia in children?

bone marrow biopsy

The nurse is planning activity for a 4-year-old child with anemia. Which activity should the nurse plan for this child?

c. Puppet play in the child's room

Iron dextran is ordered for a young child with severe iron deficiency anemia. Nursing considerations include to:

c. inject deeply into a large muscle.

Several blood tests are ordered for a preschool child with severe anemia. The child is crying and upset because of memories of the venipuncture done at the clinic 2 days ago. The nurse should explain:

c. topical application of local anesthetic can eliminate venipuncture pain.

The nurse is caring for a child with acute renal failure. Which clinical manifestation should the nurse recognize as a sign of hyperkalemia?

cardiac arrhythmia

A child with leukemia is receiving triple intrathecal chemotherapy consisting of methotrexate, cytarabine, and hydrocortisone. The purpose of this is to prevent:

central nervous system (CNS) disease.

What should the nurse teach parents about oral hygiene for the child receiving chemotherapy?

check for ulcers daily oral care 4 x day

Which is instituted for the therapeutic management of minimal change nephrotic syndrome?

corticosteroids

A hospitalized child with minimal change nephrotic syndrome is receiving high doses of prednisone. Which is an appropriate nursing goal related to this?

prevent infection

The nurse notes that a child has lost 8 pounds after 4 days of hospitalization for acute glomerulonephritis. This is most likely the result of:

reduction of edema

The nurse is teaching parents about prevention of urinary tract infections in children. Which factor predisposes the urinary tract to infection?

short urethra in girls

The nurse is conducting teaching for an adolescent being discharged to home after a renal transplant. The adolescent needs further teaching if which statement is made?

"I am glad I only have to take the immunosuppressant medication for two weeks."

anterior fontanel

12-18 mths

Which child should the nurse document as being anemic?

14-year-old child with a hemoglobin of 10 g/dl

When both parents have sickle cell trait, which is the chance their children will have sickle cell anemia?

25%

posterior fontanel

6-8 wks

child urine

1 ml/kg/hr

newborn urine amount

1-2 ml/kg/hr

Which is an advantage of peritoneal dialysis?

Parents and older children can perform treatments.

A school-age child with chronic renal failure is admitted to the hospital with a serum potassium level of 5.2 mEq/L. Which prescribed medication should the nurse plan to administer?

Sodium polystyrene sulfonate (Kayexalate)

suddenly begins to wheeze and have severe urticaria. Which is the most appropriate nursing action?

Stop drug infusion immediately.

The nurse should base a response to a parent's question about the prognosis of acute lymphoblastic leukemia (ALL) on the knowledge that

The majority of children go into remission and remain symptom free when treatment is completed.

The nurse is preparing a child for possible alopecia from chemotherapy. Which should be included?

Explain to child that when hair regrows, it may have a slightly different color or texture.

Which statement is descriptive of renal transplantation in children?

It is the preferred means of renal replacement therapy in children.

s/s of vaso crisis

PAIN, swelling tx pain then fluids

appendicitis

RLQ, Murphys pt if no more pain it ruptured

fixed pupil r/t

trauma to brain, inc ICP

When a child has chronic renal failure, the progressive deterioration produces a variety of clinical and biochemical disturbances that eventually are manifested in the clinical syndrome known as:

uremia retention of nitro products producing toxic symptoms

A mother asks the nurse what would be the first indication that acute glomerulonephritis is improving. The nurse's best response should be that the:

urinary output will increase

The nurse is caring for an infant with a suspected urinary tract infection. Which clinical manifestations should be expected?

vomit fail to gain weight persistant diaper rash

sign of brain tumor

vomit, headache

older kids suicide

w/ guns

Which is a major complication in a child with chronic renal failure?

water and sodium retention

Which should the nurse recommend to prevent urinary tract infections in young girls?

wear cotton underpants

Which clinical finding is an overt sign of retinoblastoma in children?

whitish reflex in the eye

number 1 cause of death in little ones

mote vehicle injury

The nurse is aware that an abdominal mass found in a 10-month-old infant corresponds with which childhood cancer?

neuroblastoma

CNS tumor is neuroblastoma

not many s/s usually already METS when s/s appear poor diagnosis

What is the most appropriate nursing action when the nurse notes a reddened area on the forearm of a neutropenic child with leukemia?

notify physician

number 1 impact on growth / development

nutrition

Which best describes acute glomerulonephritis?

occurs after strep

The nurse is conducting a staff in-service on newborn defects of the genitourinary system. Which describes the narrowing of the preputial opening of the foreskin?

phimosis

lime disease

deer tick, bulls eye rash spreads if progresses causes arthritits

epiglottis

drooling tripod irritable do not open mouth

A school-age child has been admitted to the hospital with an exacerbation of nephrotic syndrome. Which clinical manifestations should the nurse expect to assess?

facial edema fatigue frothy urine

osteosarcoma

femur, long bongs leg must be amputated phantom leg pain real be honest w/ child

most common cause of sudden acute kidney fail

hemolytic uremic syndrome

control hemorrhaging by

platelets

triple chemo

prevents CNS

nurse giving chemo, child has rxn

stop it call DR

adolescent boys should

testicular exam

greatest risk for separation anxiety

toddler

lumbar puncture for leukemia diagnoses

CNS involvement

Calcium carbonate is given with meals to a child with chronic renal disease. The purpose of this is to:

bind phosphorus

The nurse is admitting a school-age child in acute renal failure with reduced glomerular filtration rate. Which urine test is the most useful clinical indication of glomerular filtration rate?

creatinine

osteosarcoma mostly in

femur

The nurse is teaching parents of an infant about the causes of iron deficiency anemia. Which statement best describes iron deficiency anemia in infants?

Clinical manifestations are similar regardless of the cause of the anemia.

Hematopoietic stem cell transplantation (HSCT) is the standard treatment for a child in his or her first remission with what cancer?

Acute myeloblastic leukemia (AML)

Which should the nurse include when teaching the mother of a 9-month-old infant about administering liquid iron preparations?

Adequate dosage will turn the stools a tarry green color.

A school-age child with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time. Which is the most appropriate nursing action to prevent or minimize these reactions with subsequent treatments?

Administer an antiemetic before chemotherapy begins.

The nurse is conducting a staff in-service on childhood blood disorders. Which describes the pathology of idiopathic thrombocytopenic purpura?

An excessive destruction of platelets

In which of the conditions are all the formed elements of the blood simultaneously depressed?

Aplastic anemia

s/s of chemo

anorexia give pt antiemetic before

cord blood

bone marrow and peripheral blood is rich marrow

child resection brain tumor cushings triad bc of increased ICP

bradycardia, irregular respirations, & HTN

myelosuppresion

caused by chemo agents or malignancies leukemia, causes bleeding bc of platelets

The nurse is conducting an assessment on a school-age child with urosepsis. Which assessment finding should the nurse expect?

fever with positive blood culture

While completing an assessment on a 6-month-old infant, which finding should the nurse recognize as a symptom of a brain tumor in an infant?

inc head circumference

Which is a common side effect of short-term corticosteroid therapy?

increased appetite

Parents of a child with sickle cell anemia ask the nurse, "What happens to the hemoglobin in sickle cell anemia?" Which statement by the nurse explains the disease process?"

Normal adult hemoglobin is replaced by abnormal hemoglobin.

The nurse notes that a child's gums bleed easily and he has bruising and petechiae on his extremities. What laboratory values are consistent with these symptoms?

Platelet count of 19,000/mm3 normal platelets = 150-400K

What is an expected physical assessment finding for an adolescent with a diagnosis of Hodgkin disease?

enlarged, painless, firm cervical lymph nodes

The nurse is reviewing first aid with a group of school nurses. Which statement made by a participant indicates a correct understanding of the information?

"If a child has a nosebleed, I should have the child sit up and lean forward."

What is the nurse's best response to a mother whose child has a diagnosis of acute lymphoblastic leukemia and is expressing guilt about not having responded sooner to her boy's symptoms?

"It is not uncommon for parents not to notice subtle changes in their children's health."

The nurse is teaching parents of a child with chronic renal failure (CRF) about the use of recombinant human erythropoietin (rHuEPO) subcutaneous injections. Which statement indicates the parents have understood the teaching?

"The red blood cell count should begin to improve with these injections."

The nurse is teaching the parent about the diet of a child experiencing severe edema associated with acute glomerulonephritis. Which information should the nurse include in the teaching?

"You will need to avoid adding salt to your child's food."

Which statement, if made by a nurse to the parents of a child with leukemia, indicates an understanding of teaching related to home care associated with the disease?

"Your son's temperature should be taken frequently."

The parents of a child hospitalized with sickle cell anemia tell the nurse that they are concerned about narcotic analgesics causing addiction. Which is appropriate for the nurse to explain about narcotic analgesics?

Rarely cause addiction because they are medically indicated

Which is an objective of care for a 10-year-old child with minimal change nephrotic syndrome?

Reduce excretion of urinary protein.

What should the nurse recognize as symptoms of a brain tumor in a school-age child for whom she is caring?

Blurred vision Vomiting when getting out of bed Intermittent headache Declining academic performance

A young child with leukemia has anorexia and severe stomatitis. The nurse should suggest that the parents try which intervention?

Relax any eating pressures.

Which is the most effective pain-management approach for a child who is having a bone marrow aspiration?

Conscious or unconscious sedation

The nurse is teaching parents about the importance of iron in a toddler's diet. Which explains why iron deficiency anemia is common during toddler-hood?

Milk is a poor source of iron.

A child with non-Hodgkin lymphoma will be starting chemotherapy. What intervention is initiated before chemotherapy to prevent tumor lysis syndrome?

Intravenous (IV) hydration containing sodium bicarbonate

The nurse is recommending how to prevent iron deficiency anemia in a healthy, term, breast-fed infant. Which should be suggested?

Iron-fortified infant cereal by age 4 to 6 months

Which immunization should not be given to a child receiving chemotherapy for cancer?

MMR

Which clinical manifestation would be seen in a child with chronic renal failure?

Unpleasant "uremic" breath odor

Which is most descriptive of the pathophysiology of leukemia?

Unrestricted proliferation of immature white blood cells (WBCs) occurs.

A preschool child is being admitted to the hospital with dehydration and a urinary tract infection (UTI). Which urinalysis result should the nurse expect with these conditions?

WBC >2; specific gravity 1.030

Parents of a hemophiliac child ask the nurse, "Can you describe hemophilia to us?" Which response by the nurse is descriptive of most cases of hemophilia?

X-linked recessive inherited disorder in which a blood-clotting factor is deficient

The nurse is preparing to give oral care to a school-age child with mucositis secondary to chemotherapy administered to treat leukemia. Which preparations should the nurse use for oral care on this child?

a. Chlorhexidine gluconate (Peridex) c. Antifungal troches (lozenges) d. Lip balm (Aquaphor)

The nurse is admitting a child with a Wilms tumor. Which is the initial assessment finding associated with this tumor?

abd swelling

A school-age child is admitted in vasoocclusive sickle cell crisis. The child's care should include:

adequate hydration and pain management.

The nurse is planning care for a school-age child admitted to the hospital with hemophilia. Which interventions should the nurse plan to implement for this child?

b. Avoidance of IM injections c. Acetaminophen (Tylenol) for mild pain control d. Soft tooth brush for dental hygiene

Which should the nurse teach about prevention of sickle cell crises to parents of a preschool child with sickle cell disease?

b. Notify the health care provider if a fever of 38.5° C (101.3° F) or greater occurs. c. Give penicillin as prescribed. e. Notify the health care provider if your child begins to develop symptoms of a cold.

Myelosuppression, associated with chemotherapeutic agents or some malignancies such as leukemia, can cause bleeding tendencies because of a(n):

decrease in blood platelets.

A possible cause of acquired aplastic anemia in children is:

drugs AB chemo

A child is admitted with acute glomerulonephritis. The nurse should expect the urinalysis during this acute phase to show:

hematuria, proteinuria

The nurse closely monitors the temperature of a child with minimal change nephrotic syndrome. The purpose of this assessment is to detect an early sign of which possible complication?

infection

Meperidine (Demerol) is not recommended for children in sickle cell crisis because it:

it may induce seizures

Children with non-Hodgkin lymphoma are at risk for complications resulting from tumor lysis syndrome (TLS). The nurse should assess for

kidney failure

A child with a history of fever of unknown origin, excessive bruising, lymphadenopathy, anemia, and fatigue is exhibiting symptoms most suggestive of

leukemia

Which should the nurse recommend for the diet of a child with chronic renal failure?

low phosphorus

The nurse is conducting an admission assessment on a school-age child with acute renal failure. Which are the primary clinical manifestations the nurse expects to find with this condition?

oliguria and HTN

Which nursing intervention should not be included in the postoperative plan of care for a child undergoing surgery for a brain tumor?

placing child in trendelenburg this is not OK bc it inc ICP/risk of bleeding

Which is often administered to prevent or control hemorrhage in a child with cancer?

platelets

What fluid is the best choice when a child with mucositis asks for something to drink?

popsicles