Ricci CH 46

The nurse is educating the parents of a 4-year-old boy with a Wilms tumor who is about to have chemotherapy prior to surgery. Which statement by the parents indicates that the nurse should review the instructions about preventing infection? A) "He takes his antibiotic twice a day." B) "We check his temperature orally." C) "We keep him away from crowds." D) "He must be clean and his teeth brushed."

A) "He takes his antibiotic twice a day."

The nurse is assessing a child with aplastic anemia. Which of the following would the nurse expect to assess? Select all that apply. A) Ecchymoses B) Tachycardia C) Guaiac-positive stool D) Epistaxis E) Severe pain F) Warm tender joints

A) Ecchymoses B) Tachycardia C) Guaiac-positive stool D) Epistaxis

When evaluating the hemogram of an 8-month-old infant, the nurse would identify which type of hemoglobin as being the predominant type? A) Hemoglobin A B) Hemoglobin F C) Hemoglobin A2 D) Hemoglobin S

A) Hemoglobin A

The nurse is caring for a 13-year-old boy with acute myelogenous leukemia who is experiencing feelings of powerlessness due to the effects of chemotherapy. Which of the following interventions will best help the teen's sense of control? A) Involving the boy in decisions whenever possible B) Acknowledging the boy's feelings of anger with the disease C) Providing realistic expectations of treatments and outcomes D) Recognizing abilities that are unaffected by the disease

A) Involving the boy in decisions whenever possible

When providing care to a child with aplastic anemia, which nursing diagnosis most likely would be the priority? A) Risk for injury B) Imbalanced nutrition, less than body requirements C) Ineffective tissue perfusion D) Impaired gas exchange

A) Risk for injury

The mother of a 5-year-old girl brings the child to the clinic for an evaluation. The mother tells the nurse, "She seems to be so tired and irritable lately. And she looks so pale." Further assessment reveals pale conjunctiva and oral mucous membranes. The nurse suspects iron- deficiency anemia. Which additional finding would help provide additional evidence for this suspicion? A) Spooned nails B) Negative splenomegaly C) Oxygen saturation: 99% D) Bradycardia

A) Spooned nails

The nurse is assessing a 13-year-old girl with a family history of kidney cancer who has come to the clinic complaining of abdominal pain, nausea, and vomiting. Which of the following findings would the nurse identify as least likely indicative of cancer in a child? A) The child reports rectal bleeding and diarrhea. B) Observation reveals an asymmetric abdomen. C) The child experiences a broken bone without trauma. D) Palpation determines an abdominal mass.

A) The child reports rectal bleeding and diarrhea.

The nurse is teaching the parents of a child diagnosed with iron-deficiency anemia about ways to increase their child's intake of iron. The parents demonstrate understanding of the teaching when they identify which foods as good choices for the child? Select all that apply. A) Tuna B) Salmon C) Tofu D) Cow's milk E) Dried fruits

A) Tuna B) Salmon C) Tofu E) Dried fruits

A nurse is leading a discussion with a group of new mothers about newborn nutrition and its importance for growth and development. One of the mothers asks, "Doesn't the baby get iron from me before birth?" Which response by the nurse would be most appropriate? A) "You give the baby some iron, but it is not enough to sustain him after birth." B) "Because the baby grows rapidly during the first months, he uses up what you gave him." C) "The iron you give him before birth is different from what he needs once he is born." D) "If the baby didn't use up what you gave him before birth, he excretes it soon after birth."

B) "Because the baby grows rapidly during the first months, he uses up what you gave him."

The nurse is caring for a 12-year-old boy with idiopathic thrombocytopenia. The nurse is providing discharge instructions about home care and safety recommendations to the boy and his parents. Which response indicates a need for further teaching? A) "We should avoid aspirin and drugs like ibuprofen." B) "He can resume participation in football in 2 weeks." C) "Swimming would be a great activity." D) "Our son cannot take any antihistamines."

B) "He can resume participation in football in 2 weeks."

A child with suspected sickle cell disease is scheduled for a hemoglobin electrophoresis. When reviewing the child's history, which of the following would the nurse identify as potentially interfering with the accuracy of the results? A) Use of iron supplementation B) Blood transfusion 1 month ago C) Lack of fasting for 12 hours D) History of recent infection

B) Blood transfusion 1 month ago

The nurse is caring for an 8-year-old girl who has been diagnosed with leukemia and will have a variety of tests, including a lumbar puncture, before beginning chemotherapy. Which of the following would be the priority? A) Applying EMLA to the lumbar puncture site B) Educating the child and family about the testing procedures C) Administering promethazine as ordered for nausea D) Educating the family about chemotherapy and its side effects

B) Educating the child and family about the testing procedures

A nurse is providing care to a child with idiopathic thrombocytopenic purpura with a platelet count of 18,000/mm3. Which medication would the nurse most likely expect to be ordered? A) Folic acid B) Intravenous immune globulin C) Dimercaprol D) Deferoxamine

B) Intravenous immune globulin

A child is prescribed monthly injections of vitamin B12. When developing the teaching plan for the family, the nurse would focus on which type of anemia? A) Aplastic anemia B) Pernicious anemia C) Folic acid anemia D) Sickle cell anemia

B) Pernicious anemia

The nurse is evaluating the laboratory test results of a 7-year-old child with a suspected hematologic disorder. Which finding would cause the nurse to be concerned? A) WBC: 5.6 × 10^3/mm3 B) RBC: 2.8 × 10^6/mm3 C) Hemoglobin: 11.4 mg/dL D) Hematocrit: 35%

B) RBC: 2.8 × 10^6/mm3

A child with iron-deficiency anemia is prescribed ferrous fumarate, 3 mg/kg/day in two divided doses. The nurse interprets this order as indicating which of the following? A) The child requires a prophylactic dose of iron. B) The child has mild to moderate iron deficiency. C) The child has severe iron deficiency. D) The child is being prepared for packed red blood cell administration.

B) The child has mild to moderate iron deficiency.

The nurse is assessing a 3-year-old boy whose parents brought him to the clinic when they noticed that the right side of his abdomen was swollen. Which of the following findings would suggest this child has a neuroblastoma? A) The child has a maculopapular rash on his palms. B) The parents report that their son is vomiting and not eating well. C) The parents report that their son is irritable and not gaining weight. D) Auscultation reveals wheezing with diminished lung sounds.

B) The parents report that their son is vomiting and not eating well.

A 5-year-old girl is diagnosed with iron-deficiency anemia and is to receive iron supplements. The child has difficulty swallowing tablets, so a liquid formulation is prescribed. After teaching the parents about administering the iron supplement, which statement indicates the need for additional teaching? A) "She needs to eat foods that are high in fiber so she doesn't get constipated." B) "We'll try to get her to drink lots of fluids throughout the day." C) "We will place the liquid in the front of her gums, just below her teeth." D) "We need to measure the liquid carefully so that we give her the correct amount."

C) "We will place the liquid in the front of her gums, just below her teeth."

A nurse is conducting a physical examination of a 5-year-old with suspected iron- deficiency anemia. How would the nurse evaluate for changes in neurologic functioning? A) "Open your mouth so I can look inside your cheeks and lips." B) "Do you have any bruises on your feet or shins?" C) "Will you show me how you walk across the room?" D) "Let me see the palms of your hands and soles of your feet."

C) "Will you show me how you walk across the room?"

The nurse is caring for a 9-year-old boy who is having chemotherapy. The nurse is developing a teaching plan for the child and family about nutrition. Which of the following would the nurse be least likely to include? A) Emphasizing the intake of grains, fruits, and vegetables B) Featuring high-fiber foods if opioid analgesics are being taken C) Concentrating on consuming primarily high-calorie shakes and puddings D) Avoiding milk products if diarrhea is a problem

C) Concentrating on consuming primarily high-calorie shakes and puddings

The nurse is reviewing the white blood cell differential of a 4-year-old girl. Which value would lead the nurse to be concerned? A) Bands: 8% B) Segs: 28% C) Eosinophils: 10% D) Basophils: 0%

C) Eosinophils: 10%

The nurse is reviewing the laboratory test results of a child diagnosed with disseminated intravascular coagulation (DIC). Which of the following would the nurse interpret as indicative of this disorder? A) Shortened prothrombin time B) Increased fibrinogen level C) Positive fibrin split products D) Increased platelets

C) Positive fibrin split products

The nurse is teaching the parents of a child with a hematologic disorder about the functions of the various blood cells. The nurse determines that the teaching was successful when the parents state which blood cell as being primarily responsible for blood clotting? A) Granulocytes B) Erythrocytes C) Thrombocytes D) Leukocytes

C) Thrombocytes

The nurse is caring for a 2-year-old boy with hemophilia. His parents are upset by the possibility that he will become infected with hepatitis or HIV from the clotting factor replacement therapy. Which response by the nurse would be most appropriate? A) "Parents commonly fear the worst; however, the factor will help your child lead a normal life." B) "There are risks with any treatment including using blood products, but these are very minor." C) "Although factor replacement is expensive, there's more financial strain from missing work if he has a bleeding episode." D) "Since dry heat treatment of the factor began in 1986, there have been no reports of virus transmission."

D) "Since dry heat treatment of the factor began in 1986, there have been no reports of virus transmission."

The nurse is caring for a child who has been admitted for a sickle cell crisis. Which of the following would the nurse do first to provide adequate pain management? A) Administer a nonsteroidal anti-inflammatory drug as ordered. B) Use guided imagery and therapeutic touch. C) Administer meperidine as ordered. D) Initiate pain assessment with a standardized pain scale.

D) Initiate pain assessment with a standardized pain scale.

The nurse is caring for a 7-year-old girl who is undergoing a stem cell transplant. Which of the following would the nurse include in the child's postoperative plan of care? A) Assessing for petechiae, purpura, bruising, or bleeding B) Limiting blood draws to the minimum volume required C) Administering antiemetics around the clock as ordered D) Monitoring for severe diarrhea and maculopapular rash

D) Monitoring for severe diarrhea and maculopapular rash

The nurse is caring for a 16-year-old boy with acute myelogenous leukemia who is having chemotherapy and who has incomplete records for varicella zoster immunization. Which of the following will be the priority nursing diagnosis? A) Pain related to adverse effects of treatment verbalized by the child B) Nausea related to side effects of chemotherapy verbalized by the child C) Constipation related to the use of opioid analgesics for pain D) Risk for infection related to neutropenia and immunosuppression

D) Risk for infection related to neutropenia and immunosuppression

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? a. "ITP is primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason." b. "ITP is a serious bleeding disorder characterized by a decreased, absent, or dysfunctional coagulation." c. "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." d. "ITP is characterized by the loss of surface area on the red blood cell membrane."

a. "ITP is primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason." Explanation: 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. 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 dietary interventions for a 5-year-old with an iron deficiency. Which response indicates a need for further teaching? a. "Red meat is a good option; he loves the hamburgers from the drive-thru." b. "He will enjoy tuna casserole and eggs." c. "There are many iron fortified cereals that he likes." d. "I must encourage a variety of iron-rich foods that he likes."

a. "Red meat is a good option; he loves the hamburgers from the drive-thru." Explanation: While iron from red meat is the easiest for the body to absorb, the nurse must limit fast food consumption from the drive-thru as it is also high in fat, fillers, and sodium. The other statements are correct.

A nurse is reviewing the laboratory test results of a 3-year-old child. Which absolute neutrophil count would the nurse identify as indicating neutropenia? a. 1.0 b. 1.5 c. 2.0 d. 2.5

a. 1.0 Explanation: The normal absolute neutrophil count (ANC) ranges from 1.5 to 8.0 (1500 to 8000/mm3). An ANC less than 1.5 (1500/mm3) in children over age 1 indicates neutropenia.

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? a. 150 ml/kg of fluids b. 110 ml/kg of fluids c. 130 ml/kg of fluids per day d. 120 ml/kg of fluids per day

a. 150 ml/kg of fluids Explanation: To promote hemodilution in sickle cell crisis, the nurse would provide 150 ml/kg of fluids per day or as much as double maintenance, either orally or intravenously.

A client with cancer is diagnosed with typhlitis. Which emergency intervention would the nurse perform? a. Administer broad-spectrum antibiotics intravenously. b. Maintain fluid restriction to below maintenance levels. c. Monitor serum sodium levels. d. Administer diuretics.

a. Administer broad-spectrum antibiotics intravenously. Explanation: Typhlitis (neutropenic enterocolitis) is an inflammatory process of the gastrointestinal tract that occurs with the induction phase of leukemia chemotherapy. The recommended interventions for treatment are to administer broad-spectrum antibiotics or antifungals intravenously, provide supportive care to manage symptoms, and provide IV nutrition. The client should be kept NPO. The nurse should assess for any signs of bowel perforation or shock. Administering diuretics would not be needed and may cause harm. Monitoring sodium levels as well as other electrolytes would be necessary to evaluate IV nutrition.

Antiemetics are prescribed to control nausea and vomiting in the child undergoing chemotherapy. How can the nurse most effectively use these medications? a. Administer the antiemetic before starting chemotherapy. b. Provide the antiemetic as needed (PRN) when nausea and vomiting are reported. c. Use the antiemetic after it is clear that nonpharmacologic methods are not effective. d. Start the antiemetic on a scheduled basis when the chemotherapy begins to cause nausea.

a. Administer the antiemetic before starting chemotherapy. Explanation: Antiemetics are most effective when given before chemotherapy begins and then on a regular schedule to prevent nausea and vomiting throughout the administration of chemotherapy. Nonpharmacologic measures can be used in conjunction with antiemetics but not in place of them. Waiting to implement these measures could result in malnutrition.

The nurse is working with a child who is in sickle cell crisis. Treatment and nursing care for this child include which actions? Select all that apply. a. Administering oxygen b. Administering analgesics c. Maintaining fluid intake d. Promoting exercise and activity e. Administering platelets

a. Administering oxygen b. Administering analgesics c. Maintaining fluid intake Explanation: A vaso-occlusive crisis occurs when sickle-shaped cells are clumped together in a joint or organ. This causes severe pain and hypoxia to the tissues. The management for a vaso-occlusive crisis is to provide adequate pain relief, oxygen to correct the hypoxemia, and increased IV fluids to thin out viscosity and allow the cells to flow in the vascular system. Platelet administration is not indicated as part of the treatment. Children and adults experiencing a sickle cell crisis experience a high degree of pain, so exercise and activity is postponed until the crisis is over. Activity is encouraged when the child is not in crisis as it promotes growth and a positive self-image.

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? a. Apply heat to the site of bleeding. b. Apply direct pressure to the area. c. Elevate the injured area such as a leg or arm. d. Administer factor VIII replacement.

a. Apply heat to the site of bleeding. Explanation: Ice or cold compresses, not heat, would be applied to the site of bleeding. Direct pressure is applied until the bleeding stops. The injured part is elevated unless elevating would contribute to further injury. Factor VIII replacement is given to replace the missing clotting factor.

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? a. Avoiding further abdominal palpation b. Performing dressing changes to the affected area c. Administering analgesics for pain d. Preparing the child for amputation

a. Avoiding further abdominal palpation Explanation: After the initial assessment is performed on a child with Wilms tumor, further palpation of the abdomen should be avoided because the tumor is highly vascular and soft. Therefore, excessive handling of the tumor may result in tumor seeding and metastasis. Preoperatively, the child with Wilms tumor does not have a wound; therefore, dressing changes are not necessary. Although the child may experience abdominal pain, avoiding further abdominal palpation would be the priority. Surgical removal of the tumor and affected kidney is the treatment of choice for Wilms tumor. Amputation would be more likely for a child with osteosarcoma.

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? a. Bladder b. Blood c. Brain d. Kidney

a. 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.

How can the nurse most simply describe for distressed parents a rhabdomyosarcoma that has been found in their 5-year-old? a. Call it a tumor of muscle tissue b. Describe it as a bone tumor c. Explain that it develops in nerves outside the brain and spinal cord d. Indicate that the more commonly used name is Hodgkin lymphoma

a. Call it a tumor of muscle tissue Explanation: A rhabdomyosarcoma is a tumor of striated muscle that most commonly develops in the head, neck, arms, and legs, as well as in the genitourinary tract, of children.

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

a. Calling the doctor if the child gets a sore throat Explanation: Calling the doctor if the child gets a sore throat is the priority. Because of the child's impaired immune system, any sign of potential infection, such as sore throat, must be evaluated by a physician. Using acetaminophen if the child needs an analgesic, writing down phone numbers and appointments, and keeping a written copy of the treatment plan are important teaching points—but secondary to guarding against infection.

Individuals with hemophilia B have a deficiency in factor IX, which can cause excessive blood loss. What is another name for this clotting factor? a. Christmas factor b. Stuart factor c. Antihemophilic factor d. Proconvertin

a. Christmas factor Explanation: Factor IX is also known as plasma thromboplastin component or Christmas factor. Its function is to activate factor X. Factor X is the Stuart factor. Stuart factor's function is to activate factor II in the clotting cascade. Factor VIII is the antihemophilic factor. It is a platelet cofactor and also helps activate factor X. Factor VII is proconvertin. It is considered a stable factor and also acts to activate factor X.

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

a. Complete blood count (CBC) indicates hyperleukocytosis. Explanation: About 25% of children with acute myeloid leukemia present with blood counts greater than 100,000 × 109/L. 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, headache and vision problems, as well as weight loss and muscle wasting are common manifestations associated with AML. They do not require immediate intervention.

The nurse is caring for a 10-year-old girl with iron toxicity. What would the nurse expect the physician to order? a. Deferasirox b. Dimercaprol c. Edetate calcium disodium d. Succimer

a. Deferasirox Explanation: Deferasirox is indicated for iron toxicity. It binds with iron, which is removed via the kidneys. Dimercaprol is indicated for blood lead levels greater than 45 mcg/dl. It removes lead from soft tissues and bone, allowing for its excretion via the renal system. Edetate calcium disodium is indicated for blood lead levels greater than 45 mcg/dl. The medication removes lead from soft tissues and bone, allowing for its excretion via the renal system. Succimer is indicated for blood lead levels greater than 45 mcg/dl; it removes lead from soft tissues and bone, allowing for its excretion via the renal system.

An adolescent receiving chemotherapy has lost all hair and is sad about self-image. Which action should the nurse take to support this adolescent and involve the client in decision making? a. Encourage the adolescent to select hats or wigs to fit one's personality. b. Refer the adolescent to a peer support group. c. Have a Child Life specialist work with the adolescent. d. Support the adolescent's choice of comfortable clothing.

a. Encourage the adolescent to select hats or wigs to fit one's personality. Explanation: A positive body image is important, especially to an adolescent. It is important for the nurse to acknowledge the adolescent's feelings of sadness over the body changes caused by the illness. To help the adolescent have some power over the illness, the nurse should encourage the adolescent to choose wigs, hats, or scarves that fit his or her personality or even meet a goal of doing something the adolescent would not have dared to before. This could be a wig of different hair color or a big floppy hat with sequins. Whatever the choice, this gives the adolescent a feeling of being in control of the situation and able to make the decisions. Nurses should support the adolescent's choice of clothing. Most likely the adolescent will choose clothing for comfort. Loose clothing disguises weight loss or scarring while promoting self-esteem. Referring the adolescent to a support group or the help of a Child Life specialist are good interventions. Both will help the adolescent work through the feelings of loss, but neither gives the adolescent the ability to make decisions about outward appearance.

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? a. Ewing sarcoma b. Hodgkin disease c. non-Hodgkin lymphoma d. neuroblastoma

a. 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.

The pediatric nurse examines the radiographs of a client that indicate lesions on the bone. This finding is indicative of: a. Ewing sarcoma. b. Hodgkin disease. c. non-Hodgkin lymphoma. d. neuroblastoma.

a. Ewing sarcoma. Explanation: Radiographs that show lesions on the bone may indicate tumors (e.g., Ewing sarcoma, osteosarcoma) or metastasis of tumors. Osteosarcoma is the most common type of bone malignancy in children. It occurs primarily in the long bones. Ewing sarcoma is a highly malignant bone cancer. It occurs in the pelvis, chest wall, vertebrae, and midshaft of the long bones. Neuroblastomas are seen in children younger than 5 years old and arise from immature nerve cells and the adrenal glands. Hodgkin disease develops from the immune system. Non-Hodgkin lymphoma is a blood cancer.

A child with hemophilia A is scheduled for surgery. Which precautions would the nurse institute with this client? a. Handle the child gently when transferring to a stretcher. b. Caution the child not to brush the teeth before surgery. c. Do not allow a dressing to be applied postoperatively. d. Mark the client's chart to receive no analgesia.

a. Handle the child gently when transferring to a stretcher. Explanation: Hemophilia is a group of X-linked recessive disorders that prevent clot formation. The best care for the child is to prevent any bruising or bleeding so gentle handling when moving the child from the stretcher is necessary. Because the child is having surgery, infusion of clotting agents will be necessary. Analgesia will be needed postoperatively as will surgical dressings. IM injections are contraindicated because of potential bleeding. Brushing the teeth is part of normal daily hygiene.

During a physical examination of a 13-year-old boy, the nurse observes a single, enlarged, rubbery-feeling cervical lymph node in the armpit. The boy also reports unexplained loss of weight and malaise. Which condition should the nurse most suspect in this client? a. Hodgkin lymphoma b. Non-Hodgkin lymphoma c. Acute lymphoblastic leukemia (ALL) d. Acute myeloid leukemia (AML)

a. Hodgkin lymphoma Explanation: Symptoms of Hodgkin disease usually begin with the enlargement of only one painless, enlarged, rubbery-feeling cervical lymph node. Other nodes then become involved, along with the liver, spleen, bone marrow, and, eventually, the central nervous system. The child usually reports accompanying symptoms of anorexia, malaise, night sweats, and loss of weight. Fever may be present. Non-Hodgkin lymphomas tend to involve the lymph glands of the neck and chest most commonly, although axillary, abdominal, or inguinal nodes may be the first involved. If mediastinal lymph glands are swollen, the child may notice a cough or chest "tightness." Because mediastinal nodes press on the veins returning blood from the head, edema of the face may result. The first symptoms of ALL in children usually are those associated with decreased RBC production (anemia) such as pallor, low-grade fever, and lethargy. Children with AML have the same symptoms as those with ALL.

The nurse is preparing a child for diagnostic testing to diagnose disseminated intravascular coagulation (DIC). Which results would the nurse identify as indicating this condition? a. Increased D-Dimer assay b. Increased antithrombin III c. Decreased fibrogen/fibrin degradation products d. Decreased fibrinopeptide A level

a. Increased D-Dimer assay Explanation: Test results indicative of DIC include: increased D-Dimer assay, decreased antithrombin III, increased fibrogen/fibrin degradation products, and increased fibrinopeptide A level.

The nurse is caring for a child with sickle-cell anemia admitted to the pediatric unit. The child reports severe pain and fever. The nurse notes the following laboratory values: white blood cells 18,000/mm3, hemoglobin 6.6 mg/dl (66 g/L), and bilirubin 8 mg/dl (136.83 µmol/L). Which nursing action is priority? a. Initiate intravenous access. b. Administer pain medication. c. Assess the child's temperature. d. Begin an exchange transfusion.

a. Initiate intravenous access. Explanation: In a situation where the child is experiencing a sickle cell crisis, a priority nursing action is to initiate intravenous access to begin rehydrating the child to halt the sickling process. Administering pain medication and assessing temperature are also important but can be performed after ensuring IV access is obtained. An exchange transfusion may be performed if other interventions are unsuccessful.

When providing care for a child immediately after a bone marrow aspiration, which nursing action is priority? a. Monitor the site dressing and vital signs. b. Evaluate pain and administer medication. c. Educate the family on proper handwashing. d. Allow the child to play with a doll and syringe.

a. Monitor the site dressing and vital signs. Explanation: Monitoring vital signs and the dressing for signs of bleeding is a priority after bone marrow aspiration. Although providing pain medication, educating on handwashing, and allowing for therapeutic play are all important, these should only be performed after first stabilizing the child.

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? a. One pupil appears white. b. The infant tugs and pulls at one ear. c. The infant's eye appears to be protruding. d. The infant always keeps her eyes tightly closed.

a. One pupil appears white. Explanation: On examination, the child's pupil of the affected eye appears white because the red reflex is absent. Some might describe this symptom as a "cat's eye." Ear tugging, eye protrusion, and keeping the eyes closed are not manifestations of retinoblastoma.

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? a. Telling the child exactly what to expect of further treatments. b. Encouraging the child to support the wishes of her parents. c. Explaining the prognosis using accepted clinical terminology. d. Allowing the child to listen during discussions of the care plan.

a. Telling the child exactly what to expect of further treatments. Explanation: The committee recommends telling the child exactly what to expect of further treatments and procedures, explaining the prognosis in a developmentally appropriate way to ensure the child's understanding, and endeavoring to gain the child's candid opinion of the proposed care plan. It also recommends that decision-making for older children and adolescents should include the assent of the child or adolescent.

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? a. They are cell cycle-nonspecific, destroying both resting and dividing cells. b. They damage cells by acting as a substitute for a natural metabolite in an important molecule. c. They are synthesized naturally by various bacterial and fungal agents. d. They are most active in the S phase and act similarly to normal cellular metabolites necessary for cell replication.

a. They are cell cycle-nonspecific, destroying both resting and dividing cells. Explanation: Alkylating agents are cell cycle-nonspecific, destroying both resting and dividing cells. During alkylation, the hydrogen atoms of some molecules within the cell are replaced by an alkyl group. This group interferes with DNA replication and RNA transcription.

The nurse is preparing clients for diagnostic testing for cancer. Which test is used to differentiate a neuroblastoma from other tumors? a. Urine catecholamine metabolites, homovanillic acid (HVA), and vanillylmandelic acid (VMA) b. Urinalysis c. Serum chemistries d. Complete blood count (CBC) with differential

a. Urine catecholamine metabolites, homovanillic acid (HVA), and vanillylmandelic acid (VMA) Explanation: Neuroblastomas produce catecholamines. Urine catecholamine metabolites, homovanillic acid (HVA), and vanillylmandelic acid (VMA) differentiate neuroblastomas from other tumors. This exam is done by collecting a 24-hour urine specimen. Urinalysis provides general information about renal function. Serum chemistries help to evaluate the body's response to the cancer process. CBC with differential determines abnormal loss or destruction of cells that may indicate cancer or bone marrow suppression.

A nurse is assisting with a bone marrow aspiration and biopsy for a 6-year-old child. Which would be most important? a. Using aseptic technique for the procedure. b. Positioning the child on the side. c. Placing a folded blanket or pillow under the head to raise it. d. Asking the parents to leave the room for the procedure.

a. Using aseptic technique for the procedure. Explanation: The procedure is done using aseptic technique. The child is positioned based on the site of aspiration and a folded blanket or pillow is placed under the abdomen to elevate the hips. Parents should be allowed to stay in the room for emotional support.

A nurse is providing care for a child with disseminated intravascular coagulation (DIC). What would alert the nurse to possible neurologic compromise? a. Widely fluctuating blood pressure b. Equal pupillary response c. Hematuria d. Petechiae

a. Widely fluctuating blood pressure Explanation: A key aspect of the nurse's role is to assess the child for signs and symptoms of impaired tissue perfusion in the various body systems that may be affected by DIC. Unstable or abnormal blood pressure (such as wide BP fluctuations) or unequal pupil size may suggest neurologic compromise. Hematuria would suggest renal compromise. Petechiae would be indicative of bleeding into the skin.

Wilms tumor is suspected in a 5-year-old child. Which action would be avoided? a. abdominal palpation b. fiber intake c. aspirin administration d. rectal suppository use

a. abdominal palpation Explanation: If Wilms tumor is suspected, the abdomen should not be palpated. Palpating the abdomen may cause the tumor capsule to rupture, resulting in tumor spillage. Tumor spillage can change the tumor from stage I to stage II or III, depending on the amount of spillage that occurs.

The nurse is caring for a client who was diagnosed with a sickle cell crisis and currently reports acute back and joint pain. Upon examination, the nurse noted the following assessments: dry mucous membranes; poor skin turgor; poor capillary refill, and pale nail beds. Which nursing concern will the nurse identify as the priority? a. acute pain related to effects of sickling b. peripheral tissue perfusion impairment related to the effects of sickled cells c. fluid volume underload related to clustering of sickled cells d. altered skin integrity risk related to decreased mobility secondary to pain

a. acute pain related to effects of sickling Explanation: Although all the noted concerns apply, acute pain is the priority for this child. Once pain is relieved, the child will be able to relax, thus reducing the metabolic demand for oxygen and helping to end the sickling. A child with sickle cell pain generally does not like to move because movement increases the oxygen demand of the body that results in the sickling of more cells. The increased sickling of cells causes an increase in pain. This decreased mobility increases the risk of developing pressure injuries.

The nurse is caring for 9-year-old boy undergoing chemotherapy whose complete blood count (CBC) with differential reports 7% banded and 13% segmented neutrophils with a white blood cell count of 2,540. He has an oral temperature of 38.6°C (101.5°F). Which intervention would be the priority? a. administering prescribed broad-spectrum IV antibiotics b. monitoring his vital signs every 4 hours c. restricting visitors with symptoms of infection d. assessing for signs of infection every 8 hours

a. administering prescribed broad-spectrum IV antibiotics Explanation: The priority intervention for this child is administering prescribed broad-spectrum IV antibiotics. His absolute neutrophil count (ANC; calculated by adding the bands and segs [21%] and then multiplying this [0.20] by the white blood cell count [2540] to yield an ANC of 508) indicates he has neutropenia and his temperature indicates he may have an infection. Monitoring vital signs, restricting visitors with symptoms of infection, and assessing for signs of infection are valid interventions related to neutropenia but are of lesser importance at this point.

The nurse will select which meal as the best choice for a child with iron-deficiency anemia? a. cheeseburger, broccoli, and fresh strawberries b. chicken breast, French fries, and sweetened tea c. peanut butter sandwich, cheese stick, and applesauce d. two slices of pepperoni pizza and a glass of skim milk

a. cheeseburger, broccoli, and fresh strawberries Explanation: Children with iron-deficiency anemia require diets rich in iron and vitamin C (vitamin C enhances iron absorption). Meats are excellent sources of iron. Broccoli is a good source of iron, and strawberries are a good source of vitamin C. To help the body absorb the most iron from the meal, tea and foods rich in calcium (such as milk and cheese) should be avoided.

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? a. giving ferrous sulfate with orange juice between meals b. packed red blood cell transfusions c. providing a high dose of intravenous immunoglobulin weekly d. increasing the daily intake of fresh fruits and vegetables

a. giving ferrous sulfate with orange juice between meals Explanation: Treatment for iron-deficiency anemia is the administration of ferrous sulfate for a 13-year-old client with a hemoglobin at 11 g/dL (110 g/L). It should be administered with orange juice, because vitamin C helps absorb iron. It should not be taken with milk. It can cause teeth staining in children and should be given with a straw. Intravenous immunoglobulin would be administered for idiopathic thrombocytopenic purpura. The client's hemoglobin level is not severe enough to warrant blood transfusions at this time. There is also no indication the child is symptomatic. Anemia is generally diagnosed for a hemoglobin less than 12 g/dL (120 g/L) in children 12 to 14 years of age. The normal level for children 12 to 18 years of age is 14 g/dL (140 g/L). While increasing fresh fruits and vegetables is good for the client's overall health, this client needs foods specifically high in iron. These include broccoli, bananas, tomatoes, spinach, liver, nuts, dates, legumes, beef, eggs, and pork.

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? a. graft-versus-host disease b. disseminated intravascular coagulation c. graft failure d. veno-occlusive disease

a. graft-versus-host disease Explanation: Graft-versus-host disease involves the development of a maculopapular rash on the palmar and plantar surfaces of the hand and feet evolving into erythematous rash over most of body (ranging from slight redness of the skin to complete skin desquamation). Disseminated intravascular coagulation would involve signs of bleeding, including bruising, petechiae, and ecchymoses. Graft failure would be manifested by fever, infection, and a decrease in blood counts. Veno-occlusive disease would be manifested by sudden, unexpected weight gain, thrombocytopenia, jaundice, hepatomegaly, right upper quadrant pain, ascites, and encephalopathy.

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? a. headache, vision changes, and vomiting b. projectile vomiting, lethargy, and coma c. headache, epistaxis, and dizziness d. nystagmus, ataxia, and seizures

a. headache, vision changes, and vomiting Explanation: Children with any form of brain tumor develop symptoms of increased intracranial pressure: headache, vision changes, vomiting, an enlarging head circumference, or papilledema. Lethargy, projectile vomiting, and coma are late signs. Epistaxis is not usually related to a brain tumor. A growing tumor produces specific localized signs, such as nystagmus (constant horizontal movement of the eye) or visual field defects. As tumor growth continues, symptoms of ataxia, personality change (e.g., emotional lability, irritability), and seizures may occur. These would be later symptoms.

A child with cancer has developed neutropenia and is in isolation with neutropenic precautions. What nursing assessment takes priority for this child? a. infection symptoms b. vital signs c. mucositis d. bleeding

a. infection symptoms Explanation: The neutrophils are the primary means of fighting bacterial infection. When the neutrophil count is very low, the child has the potential to have an overwhelming bacterial infection. The child is at the greatest risk when the neutrophil count is less than 500/mcl (0.50 ×109/l). The nurse's priority would be to assess for signs and symptoms of infection. A bacterial infection can be life-threatening for this child. This child would be placed in neutropenic precautions. This is a form of isolation where the child is protected from health care workers and outside visitors. Among other precautions, no plants would be allowed in the room, raw fruits or vegetables would not be consumed unless washed under running water and lightly scrubbed, and the child should have no rectal examinations or medications and not experience a urinary catheterization. To prevent an infection, the nurse would administer broad spectrum antibiotics. The vital signs should be assessed every 4 hours, and alterations could indicate more problems than just infection. Mucositis occurs when there is an ulcerated oral mucosa. It should be assessed but is not the priority. Bleeding would be more related to low platelet count and not neutrophils.

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? a. keeping the child pain-free b. managing the symptoms of dyspnea c. providing emotional support d. delivering appropriate developmental care

a. keeping the child pain-free Explanation: Children die from cancer. They may die at home or in the hospital, and hospice care can be provided in either setting. Children with terminal cancer often experience a great deal of pain, particularly when death is imminent. The primary goal of caring for a dying child is the prevention and alleviation of pain. The nurse would work with the parents to determine the pharmacologic and nonpharmacologic methods which work best. Many times, dyspnea and agitation can occur as a result of pain. These symptoms are reduced with pain management. Any care to the child, even in hospice care, should be developmentally appropriate. Emotional support is a necessity, both for the child and the parents, but pain relief is the priority.

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? a. painless, enlarged lymph node b. anorexia c. weight loss d. night sweats

a. painless, enlarged lymph node Explanation: Children with Hodgkin lymphoma typically present with swollen, painless, and rubbery-feeling lymph nodes in the cervical or supraclavicular region. Depending on the extent of the disease at diagnosis, other symptoms may be present. However, this child was diagnosed in stage I (asymptomatic). If the lymph nodes of the chest are involved, the child has moved to the symptomatic stages and may experience dyspnea and cough. Chest pain may result from the pressure exerted by the enlarged nodes. General symptoms can also include fever, drenching night sweats, and weight loss.

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? a. red meat, eggs, oatmeal, and dried fruit b. chicken, corn, brown rice, and oranges c. pork, broccoli, white rice, and strawberries d. tuna salad with eggs, whole wheat crackers, and blueberries

a. red meat, eggs, oatmeal, and dried fruit Explanation: Iron-deficiency anemia occurs when the blood does not have enough iron to produce hemoglobin. The anemia can be corrected via iron supplementation, nutrition, and even blood transfusion if the anemia is severe. Foods that have the highest sources of iron include red meat, tuna, eggs, tofu, enriched grains, dried beans and peas, dried fruits, green leafy vegetables and iron-fortified breakfast cereals. The nurse should teach the meal containing red meat, eggs, oatmeal, and dried fruit has the highest amount of iron. Chicken has less iron than red meat, and corn has only a small amount. All the fruits listed have iron, but when dried, the iron levels increase. Pork has a limited amount of iron, and white rice contains almost no iron. Brown rice and whole grains contain higher iron amounts.

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: a. seizures. b. behavioral addiction. c. priapism. d. leg ulcers.

a. seizures. Explanation: Repeated use of meperidine for pain management during sickle cell crisis increases the risk of seizures when used in children with sickle cell anemia. Behavioral addiction is rarely a concern in the child with sickle cell anemia if the opioid is used for the alleviation of severe pain. Priapism is a complication of sickle cell anemia unrelated to meperidine administration. Leg ulcers are a complication of sickle cell anemia unrelated to meperidine administration.

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? a. vitamin B12 deficiency b. iron deficiency c. sickle-cell disorder d. acute blood loss

a. vitamin B12 deficiency Explanation: Vitamin B12 is necessary for the maturation of RBCs. Pernicious anemia results from deficiency or inability to use the vitamin, resulting in RBCs that appear abnormally large and are immature megaloblasts (nucleated immature red cells). Thus, pernicious anemia is one of the megaloblastic anemias. In children, the cause is more often lack of ingestion of vitamin B12 rather than poor absorption. Adolescents may be deficient in vitamin B12 if they have a long-term, poorly formulated vegetarian diet, as the vitamin is found primarily in foods of animal origin. Since the client is taking iron, iron deficiency anemia is ruled out. The blood cells in a client with sickle cell anemia are crescent-shaped and do not display the characteristics noted. There are no symptoms of blood loss or acute bleeding, as the client is otherwise healthy.

The nurse is assessing children in an ambulatory clinic. Which child would be most likely to have iron-deficiency anemia? a. A 3-month-old infant who is totally breastfed b. A 15-year-old adolescent who has heavy menstrual periods c. An 8-year-old child who carries lunch to school d. A 7-month-old infant who has started table food

b. A 15-year-old adolescent who has heavy menstrual periods Explanation: Adolescents with heavy menstrual flows lose enough blood each month to cause iron-deficiency anemia.

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. Select the order(s) that needs to be implemented immediately. Orders: a. Administer acetaminophen for headache or temperature greater than 101°F (38.3°C). b. Administer oxygen to maintain oxygen saturation greater than 95%. c. Start normal saline continuous intravenous (IV) infusion at 200 ml/hr. d. Administer 100 mcg/kg morphine IV for pain prn q4 hours. e. Initiate a regular diet as tolerated.

b. Administer oxygen to maintain oxygen saturation greater than 95%. c. Start normal saline continuous intravenous (IV) infusion at 200 ml/hr. d. Administer 100 mcg/kg morphine IV for pain prn q4 hours. Explanation: Nursing interventions should always be prioritized according to the ABCs (airway, breathing, circulation). Because the child's oxygen saturation is only 92% on room air, the nurse should apply oxygen to achieve an oxygen saturation of 95% or greater. After implementing measures to ensure a patent airway, the nurse should address circulation. In sickle cell crisis, the red blood cells (RBCs) clump together blocking microcirculation, which causes pain due to ischemia. The nurse should start intravenous (IV) fluids to prevent clumping of the RBCs to improve circulation. The child is reporting pain that is a 10 out of 10. The child will require an intravenous (IV) opioid analgesic such as morphine. The child's temperature is slightly elevated at 99.8°F (37.6°C). This is most likely due to dehydration (water is cooling, and less water in the body will increase the temperature slightly). Therefore, acetaminophen does not need to be administered. Initiating a regular diet at this time is not a priority. The child's respiratory rate of 18 breaths/min are within normal limits.

The nurse will use a special needle to start intravenous (IV) fluids through which central venous access device? a. A peripherally inserted central catheter b. An implanted port c. A tunneled central catheter d. A multilumen catheter

b. An implanted port Explanation: An implanted port requires a special (Huber) needle placed through the skin into the port, which is implanted surgically under the skin and over a bony prominence. The peripherally inserted central catheter (PICC) and tunneled catheters (Broviac, Hickman, Groshong) do not require a special needle for access. A multilumen catheter has more than one lumen but is not a port.

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? a. Drink a glass of milk b. Brush his or her teeth c. Remain in an upright position for at least 15 minutes d. Not eat or drink for one hour

b. Brush his or her teeth Explanation: To prevent staining of the teeth, the child should brush the teeth after administration of iron preparations such as ferrous sulfate. There is no need to remain upright, drink milk or to refrain from eating or drinking for one hour.

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? a. Bruising may occur in the perineal area. b. Expect menstrual bleeding to be heavy. c. Occasional skipped periods can be expected. d. The duration of each period will be short.

b. Expect menstrual bleeding to be heavy. Explanation: Females diagnosed with von Willebrand disease are at risk for menorrhagia. Bruising in the perineal area is not a risk unless there is some sort of trauma at the site. Von Willebrand disease does not cause intermittent periods or shorten the duration of menses.

Which site is most frequently used to perform a bone marrow aspiration? a. Humerus b. Iliac crest c. Rib cage d. Femur

b. 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.

Nursing students are reviewing information about childhood cancers. They demonstrate understanding of the information when they identify what as the most frequent type? a. Wilms tumor b. Leukemia c. Brain stem tumor d. Non-Hodgkin lymphoma

b. Leukemia Explanation: Although Wilms tumor, brain stem tumors, and non-Hodgkin lymphoma can occur in children, the most frequent type of cancer in children is leukemia.

The nurse is planning care for a child with idiopathic thrombocytopenic purpura. Which client education should be included? a. What foods are high in folic acid b. Not to pick or irritate the nose c. To use mainly cold water to wash d. To apply a soothing cream to lesions

b. Not to pick or irritate the nose Explanation: Idiopathic thrombocytopenic purpura (ITP) occurs as an immune response following a viral infection. It produces antiplatelet antibodies that destroy platelets. This leads to the classic symptoms of petechiae, purpura, and excessive bruising. Without adequate platelets, children bleed easily from lesions. If the child "picks" the nose, an area could be opened and bleeding could occur. Folic acid will have no effect on the disease process. The lesions are not itchy and are open or draining, so cold water washing and soothing lotions are not required.

Which intervention is best to use with the 6-year-old who has developed stomatitis as a side effect of chemotherapy? a. Limit foods to cool, clear liquids b. Practice frequent, gentle oral hygiene c. Use lidocaine rinses d. Have the child freely choose desired foods and beverages

b. Practice frequent, gentle oral hygiene Explanation: Frequent, gentle oral hygiene will keep the vulnerable oral mucosa clean and will prevent secondary infection. Offering only cool, clear liquids will limit nutrition. Freely choosing foods and beverages gives some control to the 6-year-old but is likely to result in ingestion of foods that are irritating to the mouth, lips, and throat. Lidocaine used as a rinse can create risks for children younger than 8 years because often some is swallowed, and this inhibits the gag reflex.

A child is receiving chemotherapy and develops stomatitis. The nurse identifies a nursing diagnosis of Impaired oral mucous membranes related to the effects of chemotherapy. What instructions would the nurse include in the child's plan of care? Select all that apply. a. Vigorously rub the child's gums with gauze to clean them. b. Provide various soft and bland foods to minimize further irritation. c. Have the child rinse the mouth with lukewarm water three times a day. d. Give the child acidic foods (e.g., orange juice) to cleanse the mouth. e. Apply a lip balm or petroleum jelly to prevent cracking.

b. Provide various soft and bland foods to minimize further irritation. c. Have the child rinse the mouth with lukewarm water three times a day. e. Apply a lip balm or petroleum jelly to prevent cracking. Explanation: For the child with stomatitis, the nurse should provide soft foods to prevent further abrasions, have the child rinse the mouth three times a day with lukewarm water to promote comfort and healing, avoid giving the child acidic foods that would further irritate the tissue, and apply a lip balm or petroleum jelly to prevent cracking of the lips. The nurse should offer a soft toothbrush to minimize discomfort.

A child with iron-deficiency anemia is prescribed ferrous fumarate, 3 mg/kg/day in two divided doses. What does this prescription indicate to the nurse? a. The child requires a prophylactic dose of iron. b. The child has mild to moderate iron deficiency. c. The child has severe iron deficiency. d. The child is being prepared for packed red blood cell administration.

b. The child has mild to moderate iron deficiency. Explanation: The recommended dosage for iron supplementation for a child with mild to moderate iron deficiency is 3 mg/kg/day of ferrous fumarate. A prophylactic dose is 1 to 2 mg/kg/day of up to a maximum of 15 mg elemental iron per day. Severe iron deficiency requires 4 to 6 mg/kg/day of elemental iron in three divided doses. Transfusion of packed red blood cells is reserved for the most severe cases. Prior to the transfusion of packed red blood cells, the nurse would follow specific blood bank guidelines.

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: a. destroy any remaining cancer cells. b. kill enough cancerous cells to induce remission. c. destroy any residual cancer cells. d. follow up for recurrent disease or late effects.

b. kill enough cancerous cells to induce remission. Explanation: During induction, the initial phase, intensive therapy is given to kill enough cancerous cells to induce a remission. In the consolidation phase, intensive therapy is given to destroy remaining cancer cells. The maintenance phase is a designated period during which treatment is continued to destroy any residual cancer cells. During the observation phase, therapy has ended and the child is followed up for recurrent disease or late effects of treatment.

A child is diagnosed with iron-deficiency anemia. Which diagnostic test results would the nurse expect to be altered? a. transferrin saturation b. serum ferritin c. total iron-binding capacity d. serum iron level

b. serum ferritin Explanation: During the first stage of iron deficiency, the depletion of iron stores is most commonly identified by a decrease in serum ferritin. During the second stage, the lack of transport iron is identified primarily by a decrease in transferrin saturation. A decrease in serum iron and an increase in total iron-binding capacity are likely to be evident as well.

The nurse is caring for a toddler taking ferrous sulfate for severe iron-deficiency anemia. Which report by the parent is most concerning? a. "I brush my child's teeth once every day." b. "My child's stools are darker than usual." c. "I mix ferrous sulfate with milk in a bottle." d. "My child takes ferrous sulfate after meals."

c. "I mix ferrous sulfate with milk in a bottle." Explanation: Ferrous sulfate may not be absorbed if taken with milk or tea, and if the parent mixes the medicine with milk in a bottle, there is also concern that if the child does not drink the entire amount of medication. Ferrous sulfate may be taken after meals to prevent gastrointestinal irritation. Dark stools are a common side effect of ferrous sulfate. Parents should be encouraged to brush the child's teeth thoroughly to prevent teeth staining.

A parent calls the pediatric oncology clinic about the child having headaches after chemotherapy. What is the nurse's best advice? a. Administer ibuprofen every 6 hours. b. Use an ice pack on the child's head. c. Administer acetaminophen as needed. d. Administer oral hydrocodone as needed.

c. Administer acetaminophen as needed. Explanation: Caution parents, while children are receiving chemotherapy, not to give them nonsteroidal anti-inflammatory drugs because they may interfere with blood coagulation, a problem that may already be present because of lowered thrombocyte levels. Instead, suggest they use acetaminophen to relieve a headache. Ice packs are used to prevent hair loss and do not help with headaches. Hydrocodone is not needed for a headache.

What is one advantage of an implanted port (central venous access device) that the nurse will explain to an adolescent? a. No tunneling is needed when the port is inserted. b. Flushing of the device is not necessary. c. Body appearance changes very little. d. No special procedure is necessary for removal.

c. Body appearance changes very little. Explanation: An implanted port has nothing extending through the skin and may be obvious only as a slight protrusion at the insertion site. Some tunneling from the port to a central vein is needed. Removal of the port requires a surgical procedure. Flushing of the port is necessary when used and on a regular basis.

The nurse is caring for a child who had a stem cell transplant and is being monitored for engraftment. Which nursing action is priority? a. Encourage therapeutic play activities. b. Monitor daily complete blood count (CBC). c. Ensure neutropenic precautions are in place. d. Remind parents to contact the child's school.

c. Ensure neutropenic precautions are in place. Explanation: With stem cell transplants, children are at greatest risk for infection and sepsis. The nurse should ensure neutropenic precautions are used to reduce the change of infection. Monitoring laboratory values, reminding the parent to contact the school, and encouraging therapeutic play are important, but preventing infection in the immunocompromised child is a priority.

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? a. Ask the parent if he or she has questions about the plan of care. b. Provide diversional activities for the child. c. Implement strategies to address the child's pain. d. Contact the health care provider to meet with the parent.

c. Implement strategies to address the child's pain. Explanation: In this case, the nurse's priority is to address the child's pain. The child is already receiving IV fluids and oxygen. That, in combination with analgesia, will assist in resolving the crisis. Asking the parent if he or she has questions, asking the health care provider to meet with the parent, and providing distraction for the child are all appropriate interventions, but the priority is to address the child's pain.

The nurse is developing a plan of care for a child who is to have a transfusion. Which would the nurse expect to administer because it is the most common form of transfusion? a. Washed red blood cells b. Whole blood c. Packed red blood cells d. Plasma factors

c. Packed red blood cells Explanation: Various forms of blood are available, including whole blood, packed red blood cells (RBCs), washed RBCs (as much "foreign" matter is removed as possible to reduce the possibility of blood reaction), plasma, plasma factors, platelets, white blood cells (WBCs), and albumin. Packed RBCs represent the most common form of transfusion used with children because they help minimize the risk of fluid overload.

A nurse is providing teaching to a child receiving chemotherapy and the parents. The nurse determines that the teaching was successful when the parents state that they will contact the primary health care provider if which occurs? a. The child has no appetite because of nausea. b. The child has increased urinary output or vomiting. c. The child has redness or swelling at the central venous access site. d. The child has a bruise on the arm.

c. The child has redness or swelling at the central venous access site. Explanation: The family should contact the health care provider if the child exhibits redness, swelling, or leakage at the central venous access site; or if the device has cracks, is pulled out, or does not flush. Loss of apetite, increased urinary output and vomitting, and bruising are expected adverse effects. The parent only need contact the health care provider if these effects become excessive.

A 9-month-old infant with iron-deficiency anemia is given ferrous sulfate therapy. Which assessment would best help the nurse determine that the infant is actually taking it daily? a. The reticulocyte count will have decreased. b. The infant will develop diarrhea. c. The stools will appear black. d. The infant will be more irritable than at the last visit.

c. The stools will appear black. Explanation: Oral iron supplements are dark in color because the iron is pigmented. As a result of digestion of this pigment, the stools of an infant taking iron will be dark to black. Taking iron supplements will cause constipation, not diarrhea. After treatment with iron, the reticulocyte count should be increased, not decreased. Children with iron deficiency are tired and many times irritable. With correction of the deficiency, the infant should be less irritable and have more energy.

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? a. Ask the child to rate pain on a scale 0 to 10. b. Administer antibiotics intravenously stat. c. Transfuse 1 unit of packed red blood cells. d. Provide the family with preoperative instructions.

c. 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.

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? a. plotting height and weight on a growth chart b. assessing dietary intake by addressing "picky eating" and "food jags" c. administering the measles, mumps, rubella (MMR) vaccine d. teaching the importance of taking water safety measures

c. administering the measles, mumps, rubella (MMR) vaccine Explanation: Live vaccines (viral or bacterial) should not be administered to an immunosuppressed child because of the risk of causing disease. The other health maintenance activities are important for the health maintenance of the child and should be included during the well-child visit.

The nurse is caring for a child with leukemia. Which nursing intervention would be the highest priority for this child? a. encouraging the child to share feelings b. grouping nursing care c. following guidelines for reverse isolation d. providing age-appropriate activities

c. following guidelines for reverse isolation Explanation: The child with leukemia is susceptible to infection, especially during chemotherapy. Infections such as meningitis, septicemia, and pneumonia are the most common causes of death. To protect the child from infectious organisms, follow standard guidelines for reverse isolation. Grouping nursing care to provide rest is important, but not the highest priority. Encouraging the child to share feelings and providing age-appropriate activities are important, but psychological issues are a lower priority than physical.

A nurse in the emergency department is examining a 6-month-old with symmetrical swelling of the hands and feet. The nurse immediately suspects: a. Cooley anemia. b. idiopathic thrombocytopenic purpura (ITP). c. sickle cell disease. d. hemophilia.

c. sickle cell disease. Explanation: Symmetrical swelling of the hands and feet in the infant or toddler is termed dactylitis; aseptic infarction occurs in the metacarpals and metatarsals and is often the first vaso-occlusive event seen with sickle cell disease. Symmetrical swelling of the hands and feet are not typically seen with the other conditions listed.

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? a. earache, stiff neck, or sore throat b. blisters, ulcers, or a rash appear c. temperature of 101°F (38.3°C) or greater d. difficulty or pain when swallowing

c. temperature of 101°F (38.3°C) or greater Explanation: The parents should seek medical care immediately if the child has a temperature of 101°F (38.3° C) or greater. This is because many chemotherapeutic drugs cause bone marrow suppression; the parents must be directed to take action at the first sign of infection in order to prevent overwhelming sepsis. The appearance of earache, stiff neck, sore throat, blisters, ulcers, or rashes (or difficulty/pain when swallowing) are reasons to seek medical care, but are not as grave as the risk of infection.

The nurse explains to the teenager that which alterations may occur when steroids are added to the cancer therapy regimen? a. Loss of appetite b. Nighttime itching c. Urinary incontinence d. Facial changes

d. Facial changes Explanation: Facial changes are common and include a round face with full cheeks, often reddened, described as "moon face." Weight gain and fat pads may appear in various areas of the body. Appetite is likely to increase. Urinary incontinence and nighttime itching are not related to steroid therapy.

The nurse is explaining the chemotherapeutic effect of busulfan to the parents of a child receiving the drug as treatment for a bone tumor. Which information would the nurse integrate into the explanation? a. It is a cell cycle-specific agent. b. It replicates both resting and dividing cells. c. It alters the function of the molecule. d. It is a cell cycle-nonspecific agent.

d. It is a cell cycle-nonspecific agent. Explanation: Alkylating agents, like busulfan, are cell cycle-nonspecific agents destroying both resting and dividing cells. During alkylation, the hydrogen atoms of some molecules within the cell are replaced by an alkyl group. This group interferes with DNA replication and RNA transcription. Antimetabolites alter the function of the molecule.

A child diagnosed with hemophilia presents with warm, swollen, painful joints. Which action will the nurse take first? a. Document the presence of hemarthrosis in the client's chart b. Notify the client's primary health care provider c. Assess the client's urine and stool for blood d. Prepare to administer factor replacement medication

d. 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.

In caring for a child with sickle cell disease, the highest priority goal is: a. the caregiver's anxiety will be reduced. b. the child's skin integrity will be maintained. c. the family will verbalize understanding of the disease crisis. d. The child's fluid intake will improve.

d. The child's fluid intake will improve. Explanation: The highest priority goals for this child are maintaining comfort and relieving pain. The child is prone to dehydration because of the kidneys' inability to concentrate urine, so increasing fluid intake is the next highest priority. Other goals include improving physical mobility, maintaining skin integrity, reducing the caregiver's anxiety, and increasing the caregiver's knowledge about the causes of crisis episodes — but these goals are not the highest priority.

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? a. reticulocyte count b. peripheral blood smear c. erythrocyte sedimentation rate d. hemoglobin electrophoresis

d. hemoglobin electrophoresis Explanation: If the screening test result indicates the possibility of SCA or sickle cell trait, hemoglobin (Hgb) electrophoresis is performed promptly to confirm the diagnosis. While Hgb electrophoresis is the only definitive test for diagnosis of the disease, other laboratory testing that assists in the assessment of the disease include reticulocyte count (greatly elevated), peripheral blood smears (presence of sickle-shaped cells and target cells), and erythrocyte sedimentation rate (elevated).