PrepU R ch 46
A nurse is preparing a teaching plan for a child with hemophilia and his parents. Which information would the nurse be least likely to include to manage a bleeding episode? Administer factor VIII replacement. Apply direct pressure to the area. Elevate the injured area such as a leg or arm. Apply heat to the site of bleeding.
Apply heat to the site of bleeding.
A 14-year-old adolescent with Hodgkin disease is experiencing difficulty breathing and is sent for a radiograph. Which finding should the nurse expect to see on the x-ray report? Mediastinal mass Tumor in the liver Retinoblastoma Lymphadenopathy
Mediastinal mass
The nurse is assessing a school-aged child with sickle-cell anemia. Which assessment finding is consistent with this child's diagnosis? increased growth of long bones slightly yellow sclera depigmented areas on the abdomen enlarged mandibular growth
slightly yellow sclera
The health care provider has just informed the parents of a 3-year-old that their child has leukemia. The mother begins crying and tells the nurse she does not want her baby to die. What is the nurse's best response? "Don't worry, the health care provider is very good at treating leukemia." "You are very lucky to have caught it so early; that makes the treatments easier." "I don't blame you for being upset; any parent would be scared too." "I know this is scary, but leukemia has a high cure rate in children these days."
"I know this is scary, but leukemia has a high cure rate in children these days."
The parent tell the nurse that they recently saw a "white glow" in their infant's left pupil. How should the nurse respond? "I will report this to the pediatrician." "Most parents mention a red color." "A plugged tear duct would not be unusual." "Has your infant been rubbing either eye?"
"I will report this to the pediatrician."
The parents of a 6-year-old child with idiopathic thrombocytopenic purpura (ITP) ask the nurse, "What causes this disease?" Which response by the nurse would be most appropriate? "ITP is characterized by the loss of surface area on the red blood cell membrane." "ITP is primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason." "ITP is a serious bleeding disorder characterized by a decreased, absent, or dysfunctional coagulation." "ITP occurs when the body's iron stores are depleted due to rapid physical growth, inadequate iron intake, inadequate iron absorption, or loss of blood."
"ITP is primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason."
A nurse is providing dietary interventions for a 5-year-old with an iron deficiency. Which response indicates a need for further teaching? "Red meat is a good option; he loves the hamburgers from the drive-thru." "I must encourage a variety of iron-rich foods that he likes." "There are many iron fortified cereals that he likes." "He will enjoy tuna casserole and eggs."
"Red meat is a good option; he loves the hamburgers from the drive-thru."
A nurse is conducting a class to a group of parents on sickle cell anemia. Which statement by a parent indicates teaching has been effective? "The sickle shape of red blood cells decreases oxygen to tissues." "Fluid restriction is necessary to control sickle cell anemia." "This is a hereditary disease that is transmitted by one affected gene." "Sickle cell anemia is common in people of Asian descent."
"The sickle shape of red blood cells decreases oxygen to tissues."
The nurse is preparing a presentation for a local parent group about nutritional measures to prevent anemia. The group of parents have children between the ages of 4 and 8. The nurse would recommend a daily iron intake of which amount? 12 mg 10 mg 15 mg 6 mg
10 mg
The nurse is completing the health history of a 6-month-old infant with retinoblastoma with the child's parents. Which symptom should the nurse expect that the parents have observed?
One pupil appears white.
The nurse is caring for a 6-year-old girl with leukemia who is having an oncologic emergency. Which signs and symptoms would indicate hyperleukocytosis? tachycardia and respiratory distress wheezing and diminished breath sounds bradycardia and distinct S1 and S2 sounds respiratory distress and poor perfusion
tachycardia and respiratory distress
The nurse is teaching the parents of a 15-year-old boy who is being treated for acute myeloid leukemia about the side effects of chemotherapy. For which symptoms should the parents seek medical care immediately? blisters, ulcers, or a rash appear temperature of 101°F (38.3°C) or greater earache, stiff neck, or sore throat difficulty or pain when swallowing
temperature of 101°F (38.3°C) or greater
A 9-year-old child is diagnosed with von Willebrand Disease (vWD) with the following characteristics: decreased quantities of all sizes of von Willebrand factor multimers and decreased activity of von Willebrand factor. The nurse identifies this as which type of vWD as being involved? type II type I type IIIB type III
type I
A 14-year-old girl who is a vegetarian has recently developed anemia. Blood smear results show large, fragile, immature erythrocytes. She claims to take an iron supplement regularly and is surprised to learn that she is anemic, as she is otherwise healthy. As the nurse considers all of the data in the case, which anemia will the nurse discuss when collaborating with the primary healthcare provider? sickle-cell disorder vitamin B12 deficiency acute blood loss iron deficiency
vitamin B12 deficiency
A 3-year old child is brought to the emergency department by the parents. Assessment reveals bruising and bleeding from the nose and mouth. The nurse suspects which condition? hemophilia chronic iron deficiency anemia disseminated intravascular coagulation (DIC) von Willebrand disease (vWD)
von Willebrand disease (vWD)
Which intervention is best to use with the 6-year-old who has developed stomatitis as a side effect of chemotherapy? Practice frequent, gentle oral hygiene Limit foods to cool, clear liquids Have the child freely choose desired foods and beverages Use lidocaine rinses
Practice frequent, gentle oral hygiene
The nurse is providing preoperative care for a 7-year-old boy with a brain tumor, as well as his parents. Which intervention is a priority? Educating the child and parents about shunts. Providing a tour of the intensive care unit. Assessing the child's level of consciousness. Having the child talk to another child who has had this surgery.
Assessing the child's level of consciousness.
The nurse is caring for a child with aplastic anemia. The nurse is reviewing the child's blood work and notes the granulocyte count is about 500, platelet count is over 20,000, and the reticulocyte count is over 1%. The parents ask if these values have any significance. Which response by the nurse is appropriate? "These values will help us monitor the disease." "I'm really not allowed to discuss these findings with you." "The doctor will discuss these findings with you when he comes to the hospital." "These labs are just common labs for children with this disease."
"These values will help us monitor the disease."
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 will need to lie still afterward to prevent a headache." "You will have to lie on your back and hold your breath." "The numbing medicine on your skin will keep you from having pain." "You may feel pressure on your hip during the procedure."
"You may feel pressure on your hip during the procedure."
The nurse is assessing children in an ambulatory clinic. Which child would be most likely to have iron-deficiency anemia? A 3-month-old infant who is totally breastfed A 7-month-old infant who has started table food An 8-year-old child who carries lunch to school A 15-year-old adolescent who has heavy menstrual periods
A 15-year-old adolescent who has heavy menstrual periods
The nurse is reviewing the results of a clotting study for a healthy 6-year-old. What would the nurse document as a normal prothrombin finding? 21.0 to 35.0 seconds 16.0 to 18.0 seconds 11.0 to 13.0 seconds 6.0 to 9.0 seconds
11.0 to 13.0 seconds
The nurse is caring for a child in sickle cell crisis. To best promote hemodilution, the nurse would expect to administer how much fluid per day intravenously or orally? 120 ml/kg of fluids per day 150 ml/kg of fluids 130 ml/kg of fluids per day 110 ml/kg of fluids
150 ml/kg of fluids
A client with cancer is diagnosed with typhlitis. Which emergency intervention would the nurse perform? Maintain fluid restriction to below maintenance levels. Monitor serum sodium levels. Administer diuretics. Administer broad-spectrum antibiotics intravenously.
Administer broad-spectrum antibiotics intravenously.
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 intervention would the nurse expect to perform? Administering a sedative as ordered to keep the child still. Applying EMLA to the injection site prior to inserting the IV. Encouraging fluid intake to increase radionuclide uptake. Advising the physician that the child is allergic to shellfish.
Administering a sedative as ordered to keep the child still.
A nurse is teaching a school-aged child with iron-deficiency anemia and her parents about dietary measures to increase iron intake. The nurse determines that the teaching was successful when they state which food is high in iron? Select all that apply. Fortified cereal Green leafy vegetables Milk Eggs Citrus fruits
Eggs Fortified cereal Green leafy vegetables
The child is prescribed liquid ferrous sulfate. The nurse should encourage the child to take which action immediately after each dose to best eliminate possible side effects? Drink a glass of milk Remain in an upright position for at least 15 minutes Brush his or her teeth Not eat or drink for one hour
Brush his or her teeth
The nurse is planning care for a school-aged child recovering from being hit by a motor vehicle while riding a bicycle. For what will the nurse assess to determine the onset of disseminated intravascular coagulation (DIC) in this child? bleeding from intravenous sites blurred vision nausea and vomiting sudden onset of knee pain
bleeding from intravenous sites
The nurse is caring for a child who had a stem cell transplant and is being monitored for engraftment. Which nursing action is priority? Monitor daily complete blood count (CBC). Encourage therapeutic play activities. Remind parents to contact the child's school. Ensure neutropenic precautions are in place.
Ensure neutropenic precautions are in place.
Which diagnosis would be most appropriate for an infant with a large retinoblastoma after surgery? Fear related to loss of normal vision Disturbed sensory perception related to enucleation Pain related to retinal removal Anticipatory grieving related to change in body image
Disturbed sensory perception related to enucleation
The nurse in the emergency department is caring for a 10-year-old female child with sickle cell crisis. Child rates pain 10 on a scale of 0 to 10. Vital signs: 99.8°F (37.6°C); heart rate, 122 beats/min; blood pressure, 92/50 mm Hg; respiratory rate, 26 breaths/min; oxygen saturation, 92% on room air. The nurse receives orders for the child. Click to highlight the order(s) that needs to be implemented immediately. Orders: Administer acetaminophen for headache or temperature greater than 101°F (38.3°C). Administer oxygen to maintain oxygen saturation greater than 95%. Start normal saline continuous intravenous (IV) infusion at 200 ml/hr. Administer 100 mcg/kg morphine IV for pain prn q4 hours. Initiate a regular diet as tolerated.
Administer oxygen to maintain oxygen saturation greater than 95%. Start normal saline continuous intravenous (IV) infusion at 200 ml/hr. Administer 100 mcg/kg morphine IV for pain prn q4 hours.
A nurse is preparing a teaching plan for a child with hemophilia and his parents. Which information would the nurse be least likely to include to manage a bleeding episode?
Apply heat to the site of bleeding.
Which nursing diagnosis would be most appropriate for a child with idiopathic thrombocytopenic purpura? Ineffective tissue perfusion related to poor platelet formation
Ineffective tissue perfusion related to poor platelet formation
A nurse is teaching the parents of a child with sickle cell disease about factors that predispose the child to a sickle cell crisis. The nurse determines that the teaching was successful when the parents identify what as a factor? Respiratory distress Pallor Infection Fluid overload
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? non-Hodgkin lymphoma Ewing sarcoma Hodgkin disease neuroblastoma
Ewing sarcoma
A 15-year-old client diagnosed with von Willebrand disease has reached menarche. Based on this fact, what information is most important for the nurse to convey to the client? Bruising may occur in the perineal area. The duration of each period will be short. Occasional skipped periods can be expected. Expect menstrual bleeding to be heavy.
Expect menstrual bleeding to be heavy.
Parents have just been informed that their child has a malignancy. The mother breaks down in tears, while the father appears to be in shock. What is an appropriate nursing diagnosis for this family? Fear related to diagnosis of cancer Disturbed body image related to hair loss Decisional conflict related to cancer treatment Ineffective parenting related to diagnosis of cancer
Fear related to diagnosis of cancer
The parent contacts the health care provider because their preschool-age child has a temperature of 101.5°F (38.6°C). The child received outpatient chemotherapy 1 week ago. Which is the most appropriate response by the nurse? Ask whether any family members or other close associates are ill. Instruct the parent to immediately obtain and give the antibiotic that the oncologist calls in to the pharmacy. Have the parent bring the child to the pediatric oncology clinic as soon as possible. Instruct the parent to administer acetaminophen every 4 hours until the fever dissipates.
Have the parent bring the child to the pediatric oncology clinic as soon as possible.
The nurse is caring for a child diagnosed with thalassemia. What laboratory value(s) would the nurse expect to monitor for this child? Select all that apply. Hemoglobin Urine glucose Iron level Vitamin B12 level Serum sodium
Hemoglobin Iron level
A child is diagnosed with sickle cell anemia. Which test will the nurse expect the primary health care provider to prescribe for this client? Thrombocyte level Metabolic screening test Hemoglobin level Leukocyte level
Hemoglobin level
A 3-year-old child is hospitalized with a diagnosis of sickle cell anemia and is experiencing a pain crisis. Using the FACES scale, the nurse assesses the child's pain to be a 10 on a scale of 1 to 10. The child is receiving intravenous fluids and oxygen at 2 L/min via nasal cannula. The parent is at the bedside holding the child's hand and has a concerned look. What is the nurse's priority in caring for the child? Ask the parent if he or she has questions about the plan of care. Provide diversional activities for the child. Contact the health care provider to meet with the parent. Implement strategies to address the child's pain.
Implement strategies to address the child's pain.
A 15-year-old boy has been diagnosed with an osteosarcoma 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? Heart Lungs Rib cage Brain
Lungs
The nurse is caring for a 6-year-old boy with non-Hodgkin lymphoma who is being treated with monoclonal antibodies. What recommendation would the nurse include in the child's plan of care? Assessing for signs of capillary leak syndrome. Monitoring for complaints of bone pain. Monitoring for allergic reactions or anaphylaxis. Assessing the child's hydration status secondary to vomiting.
Monitoring for allergic reactions or anaphylaxis.
The nurse is caring for a child with disseminated intravascular coagulation (DIC). The nurse notices signs of neurologic deficit. Which nursing action is appropriate? Continue to monitor neurologic signs. Evaluate respiratory status. Inspect for signs of bleeding. Notify the physician.
Notify the physician.
A nurse is providing care to a toddler with nephroblastoma and is being evaluated. Which nursing action would be most important? Preparing the child for chemotherapy Ensuring that the child be allowed nothing by mouth Preventing weight-bearing activities Placing a "no abdominal palpation" sign above the child's bed Restricting the child's visitors
Placing a "no abdominal palpation" sign above the child's bed
A child diagnosed with hemophilia presents with warm, swollen, painful joints. Which action will the nurse take first? Document the presence of hemarthrosis in the client's chart Notify the client's primary health care provider Prepare to administer factor replacement medication Assess the client's urine and stool for blood
Prepare to administer factor replacement medication
What is the priority action the nurse should take when caring for a child newly diagnosed with Wilms tumor (nephroblastoma)? Obtain a catheterized urine specimen. Control acute pain. Protect the abdomen from manipulation. Assess for constipation.
Protect the abdomen from manipulation.
A child is undergoing a series of diagnostic tests for a suspected malignancy. Which diagnostic test result is only present in Hodgkin disease? elevated lymphocytes Reed-Sternberg cells megakaryocyte cells T-lymphocyte surface markers
Reed-Sternberg cells
A child with acute lymphoblastic leukemia (ALL) is receiving methotrexate for therapy. Which nursing diagnosis would best apply during therapy? Risk for self-directed violence related to effect of methotrexate on central nervous system Risk for impaired mobility related to depressant effects of methotrexate Risk for impaired skin integrity related to oral ulcerations associated with chemotherapy Excess fluid volume related to effect of methotrexate on aldosterone secretion
Risk for impaired skin integrity related to oral ulcerations associated with chemotherapy
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? Deficient fluid volume Impaired skin integrity Risk for delayed growth and development Risk for infection
Risk for infection
The nurse is caring for a 17-year-old girl in the terminal phase of osteosarcoma. Which action demonstrates integration of the recommendations of the American Academy of Pediatrics (AAP) Committee on Bioethics? Telling the child exactly what to expect of further treatments. Explaining the prognosis using accepted clinical terminology. Allowing the child to listen during discussions of the care plan. Encouraging the child to support the wishes of her parents.
Telling the child exactly what to expect of further treatments.
The nurse is collecting data from the caregivers of a child brought to the clinic setting. The parents tell the nurse that the child's skin seems to be an unusual color. The nurse notes that the child's skin appears bronze-colored and jaundiced. This observation alerts the nurse to the likelihood that this child has which disorder? Hemophilia Kawasaki disease Thalassemia Sickle cell disease
Thalassemia
The child has been diagnosed with cancer and is being treated with chemotherapy. Which findings are common side effects of this type of treatment? Select all that apply. The child reports feeling nauseated. The child's mother states, "It seems like he catches every bug that comes along." The child has no hair on his head. The child's mother states that she often has to repeat herself because he can't hear very well. The child's teeth are enlarged.
The child reports feeling nauseated. The child's mother states, "It seems like he catches every bug that comes along." The child has no hair on his head. The child's mother states that she often has to repeat herself because he can't hear very well.
In caring for a child with sickle cell disease, the highest priority goal is: the caregiver's anxiety will be reduced. the child's skin integrity will be maintained. The child's fluid intake will improve. the family will verbalize understanding of the disease crisis.
The child's fluid intake will improve
In caring for a child with sickle cell disease, the highest priority goal is: The child's fluid intake will improve. the child's skin integrity will be maintained. the caregiver's anxiety will be reduced. the family will verbalize understanding of the disease crisis.
The child's fluid intake will improve.
The health care provider prescribes an alkylating agent as part of a child's chemotherapy regimen. When explaining this classification of drug to the child and parents, which information would the nurse integrate into the explanation? They are cell cycle-nonspecific, destroying both resting and dividing cells. They are most active in the S phase and act similarly to normal cellular metabolites necessary for cell replication. They damage cells by acting as a substitute for a natural metabolite in an important molecule. They are synthesized naturally by various bacterial and fungal agents.
They are cell cycle-nonspecific, destroying both resting and dividing cells.
The 2-year-old child receiving treatment for a cancer diagnosis is seen for a well-child checkup. Which health maintenance activity will the nurse exclude? assessing dietary intake by addressing "picky eating" and "food jags" plotting height and weight on a growth chart administering the measles, mumps, rubella (MMR) vaccine teaching the importance of taking water safety measures
administering the measles, mumps, rubella (MMR) vaccine
Which nursing intervention(s) are appropriate for the plan of care designed for a child diagnosed with hemophilia who is experiencing an episode of active bleeding? Select all that apply. applying splints to extremities administering acetaminophen as prescribed for pain encouraging self performance of active range-of-motion exercises scheduling physical therapy for 48 hours after bleeding stops performing passive range-of-motion exercises
applying splints to extremities administering acetaminophen as prescribed for pain encouraging self performance of active range-of-motion exercises scheduling physical therapy for 48 hours after bleeding stops
Which mechanism is central to cancers in children? genetics environment race cellular growth
cellular growth
A nurse caring for an 8-year-old child with a bleeding disorder documents the following nursing diagnosis: Ineffective tissue perfusion related to intravascular thrombosis and hemorrhage. This nursing diagnosis would be most appropriate for a child diagnosed with which condition?
disseminated intravascular coagulation
A child is sent to pediatric intensive care following surgery for a brain tumor. Which prescription would the nurse question? phenytoin elevate head of bed 90 degrees
elevate head of bed 90 degrees
The nurse is caring for a 4-year-old child following surgical removal of a stage I neuroblastoma. Which intervention is appropriate for this child? applying aloe vera to the postsurgical site to promote healing maintaining isolation as prescribed to avoid infection giving medications as prescribed via the least invasive route administering antiemetics as prescribed for nausea
giving medications as prescribed via the least invasive route
A child has undergone a hematopoietic stem cell transplant. When assessing the child, the nurse notes the development of a maculopapular rash on the child's palms and bottoms of the feet. Which condition would the nurse suspect? veno-occlusive disease disseminated intravascular coagulation graft failure graft-versus-host disease
graft-versus-host disease
A school nurse is teaching a group of parents about signs and symptoms of cancer in children. Which symptom is an early sign of a brain tumor? headache, epistaxis, and dizziness projectile vomiting, lethargy, and coma headache, vision changes, and vomiting nystagmus, ataxia, and seizures
headache, vision changes, and vomiting
A nurse is caring for a newborn whose screening test result indicates the possibility of sickle cell anemia (SCA) or sickle cell trait. The nurse would expect the test result to be confirmed by which lab tests? hemoglobin electrophoresis erythrocyte sedimentation rate reticulocyte count peripheral blood smear
hemoglobin electrophoresis
The nurse is providing care at a local clinic that treats children with hemophilia. The nurse understands that if bleeding is not treated effectively, the children are at high risk for development of chronic disabling disease involving the: heart. kidneys. joints. liver.
joints
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 providing emotional support delivering appropriate developmental care managing the symptoms of dyspnea
keeping the child pain-free
A nurse is caring for a child with Hodgkin disease who is in the induction phase of a chemotherapy regimen. The nurse explains to the parents that the goal of this phase is to: follow up for recurrent disease or late effects. destroy any residual cancer cells. destroy any remaining cancer cells. kill enough cancerous cells to induce remission.
kill enough cancerous cells to induce remission.
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)? hemoglobin (Hgb) of 11.2 g/dl (112 g/L) decreased white blood cells (WBCs) macrocytic red blood cells (RBCs) platelet count of 250,000
macrocytic red blood cells (RBCs)
What are important considerations when the nurse is planning care for the family of a child with cancer? Select all that apply. monitoring for side effects of treatment family's coping strategies stage of grief of child, parents, and siblings prevention and alleviation of pain child's gender prognosis of cancer
monitoring for side effects of treatment family's coping strategies stage of grief of child, parents, and siblings prevention and alleviation of pain prognosis of cancer
When planning the care for a child with leukemia who is receiving methotrexate, the nurse would assess the child closely for which possible effect? paresthesias of the fingers mucositis cushingoid facial appearance weight gain
mucositis
The nurse is providing care to a child and is to collect a 24-hour urine specimen for catecholamines. The nurse integrates knowledge of this testing as indicative of: neuroblastoma. Hodgkin disease. osteosarcoma. leukemia.
neuroblastoma
The nurse is reviewing the medical record of a child diagnosed with Hodgkin lymphoma at the asymptomatic stage. Which would the nurse identify as typically the first sign reported by the child? night sweats anorexia weight loss painless, enlarged lymph node
painless, enlarged lymph node
A nurse is caring for a 4-year-old male child brought to the emergency department (ED) for symptoms of influenza. The parents state the child has "had high fevers for the past 3 days even though we have been giving our child acetaminophen and they do not really want to eat or drink anything and has been very sleepy." Client opens eyes to voice, follows simple commands, and skin is very warm, ruddy, and dry. Vital signs: 101.5°F (38.6°C); heart rate, 138 beats/min; oxygen saturation, 95% on room air. Laboratory values: white blood cell (WBC) count, 43 × 103 cells/mm3 (43 × 109/l); hemoglobin, 10 mg/dl (100 g/l); hematocrit, 32% (0.32); platelets, 20,000/ml (20 × 109/l); neutrophil bands, 48/mcl (0.05 × 109/l); lymphoblasts, 33 (NA). Complete the following sentence(s) by choosing from the lists of options. The nurse should first address: risk for bleeding risk for impaired tissue perfusion risk for respiratory a
risk for bleeding implementing bleeding precautions
A child diagnosed with beta-thalassemia presents with the classic findings of hyperbilirubinemia, splenomegaly, hepatomegaly, delayed growth and sexual maturation, and abnormal facial appearance. What category of the disease do these symptoms represent? thalassemia minor thalassemia major thalassemia intermedia thalassemia minima
thalassemia major
