Ricci Ch.46 PrepU

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

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

The 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? -"I don't blame you for being upset; any parent would be scared too." -"Don't worry, the health care provider is very good at treating leukemia." -"I know this is scary, but leukemia has a high cure rate in children these days." -"You are very lucky to have caught it so early; that makes the treatments easier."

"I know this is scary, but leukemia has a high cure rate in children these days." Explanation: Although cancer in children is rare compared to unintentional injury or infection, it is the leading medical cause of death among persons younger than 25 years of age. Fortunately, the overall survival rate for children with cancer today has improved. The overall 5-year survival rate is 84.5%, and for acute lymphoblastic leukemia (the most common form of childhood cancer), the 5-year survival is 88.5%

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

"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.

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 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."

"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.

The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with sickle cell disease. The nurses in the group make the following statements. Which statement is most accurate regarding this condition? -"The disease is most often seen in individuals of Asian decent." -"If the trait is inherited from both parents the child will have the -disease." -"The trait or the disease is seen in one generation and skips the next generation." -"Males are much more likely to have the disease than females."

"If the trait is inherited from both parents the child will have the disease." Explanation: When the trait is inherited from both parents (homozygous state), the child has sickle cell disease, and anemia develops. The trait does not skip generations. The trait occurs most commonly in black clients. Either sex can have the trait and disease.

The nurse is reinforcing teaching with a group of caregivers of children diagnosed with iron-deficiency anemia. One of the caregivers tells the group, "I give my child ferrous sulfate." Which statement made by the caregivers is correct regarding giving ferrous sulfate? -"My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C." -"I always give the ferrous sulfate with meals." -"We watch closely for any diarrhea since that usually happens when he takes ferrous sulfate." -"When I give my son ferrous sulfate I know he also needs potassium supplements."

"My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C." Explanation: When ferrous sulfate is administered, it should be given between meals with juice (preferably orange juice, because vitamin C aids in iron absorption). For best results, iron should not be given with meals. Ferrous sulfate can cause constipation or turn the child's stools black.

A parent is angry about the adolescent's diagnosis of osteosarcoma. The parent is telling the adolescent that if he hadn't played football last year and broken his leg, this would not have happened. What is the nurse's best response to the parent's statement? -"Playing sports does not cause osteosarcoma. It may draw attention to the weakened bone from the tumor, though." -"When your adolescent broke the leg last year, it may have weakened the bone, allowing cancer to start there." -"Does bone cancer run in your family? Maybe your adolescent inherited it through genes." -"Cancer in the bone can result from old injuries so it probably was not caused from getting hurt last year, but an earlier injury."

"Playing sports does not cause osteosarcoma. It may draw attention to the weakened bone from the tumor, though." Explanation: Osteosarcoma does not result from bone injuries but may be diagnosed when there is a fracture secondary to bone weakening from the tumor. Playing sports has no effect on development of osteosarcoma.

A mother asks the nurse why her infant who was born at 34 weeks' gestation is being prescribed ferrous sulfate. Which response by the nurse is most appropriate? -"Ferrous sulfate helps improve red blood cell formation." -"Infants with pyloric stenosis require ferrous sulfate." -"Preterm infants are at risk for iron-deficiency anemia." -"Your infant may have been having excessive diarrhea."

"Preterm infants are at risk for iron-deficiency anemia." Explanation: Infants born prematurely are at risk for iron-deficiency anemia because iron stores are built during the last few weeks of gestation. Although some infants with pyloric stenosis may require an iron supplement, such as ferrous sulfate, not all infants will. Infants with excessive diarrhea may develop iron-deficiency anemia, and ferrous sulfate helps improve red blood cell formation, but this does not explain why a preterm infant is being prescribed an iron supplement.

The parents of a child diagnosed with rhabdomyosarcoma ask the nurse to explain what this means. What is the nurse's best response? -"There is a tumor in the bone." -"This is a tumor of the kidney." -"The tumor is in the muscle." -"There is a tumor in the eye."

"The tumor is in the muscle." Explanation: A rhabdomyosarcoma is a tumor of striated muscle. A nephroblastoma (Wilms tumor) is a malignant tumor that rises from the metanephric mesoderm cells of the upper pole of the kidney. Retinoblastoma is a malignant tumor of the retina of the eye. Ewing sarcoma occurs in the bone.

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? -"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." -"I'm really not allowed to discuss these findings with you."

"These values will help us monitor the disease." Explanation: This response answers the parent's questions. In the nonsevere form, the granulocyte count remains about 500, the platelets are over 20,000, and the reticulocyte count is over 1%. The other responses do not address what the parents are asking and would block therapeutic communication.

A child is to receive an oral corticosteroid as part of the treatment regimen for leukemia. After teaching the child and family about this drug, the nurse determines the need for additional teaching when they state: -"We should administer the drug on an empty stomach." -"We should check our son's urine for glucose." -"We will need to gradually decrease the dosage." -"He might develop a rounded face from this drug."

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

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

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

WBC: 5100/uL (5.1x10^8/L) RBC: 3.2x10^5/uL (3.2x10^12/L) Hgb: 7.5 g/dL (75 g/L) Htc: 23.1% (0.23) Plt: 178x10^3/uL (178x10^9/L) A nurse is reviewing the above laboratory results for a 6-year-old child during a pediatric clinic visit. Based on the laboratory results, what question is most appropriate for the nurse to ask the parents? -"Have you noticed any color changes in your child's bowel movements?" -"Has your child been exposed to any illnesses lately?" -"What has your child's activity level been like recently?" -"Have you noticed any unexplained bruising on your child?"

"What has your child's activity level been like recently?" Explanation: The hemoglobin/hematocrit levels and red blood cell count indicate anemia. Anemia can cause fatigue, hence the most appropriate question would be to ask about the child's activity level. If the white blood cell count was high, that might indicate infection. Unexplained bruising would be reflected in a low platelet count (178 ×103/μL; 178 ×109/L is the low end of normal).

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 may feel pressure on your hip during the procedure." -"The numbing medicine on your skin will keep you from having pain." -"You will have to lie on your back and hold your breath." -"You will need to lie still afterward to prevent a headache."

"You may feel pressure on your hip during the procedure." Explanation: The bone marrow aspiration is performed on the iliac crest if the child is older and on the femur if the child is an infant. Bone marrow aspiration requires hard pressure to allow the needle to puncture the bone. A lidocaine/prilocaine cream is applied to the skin anywhere from 1 to 3 hours prior to the procedure to help numb the site where the needle will be inserted. Bone marrow aspirations and biopsies are usually performed with conscious sedation. If the child is an infant or there are special circumstances the procedure may be performed under anesthesia. The child is placed on the side for the procedure so the health care provider has better access to the iliac crest. The child will need to rest after the procedure to prevent bleeding, but is not required to lay flat on the back. Children who have had a lumbar puncture may need to lie on the back and are at risk for a headache.

A nurse is teaching parents of a child with iron-deficiency anemia how to administer ferrous sulfate. The nurse determines that the teaching was successful when they make which statements? Select all that apply. -"We'll give him the medicine before he eats his meals." -"He has to make sure that he brushes his teeth well." -"He might get constipated, so we'll try to get him to eat some more fiber." -"We'll have him take the liquid medicine with some orange or pineapple juice." -"We can mix the liquid form of the drug with milk."

-"We'll give him the medicine before he eats his meals." -"He has to make sure that he brushes his teeth well." -"He might get constipated, so we'll try to get him to eat some more fiber." -"We'll have him take the liquid medicine with some orange or pineapple juice." Explanation: Ferrous sulfate should be given on an empty stomach with water to enhance absorption. If the child develops gastrointestinal distress, then it can be given after meals. Iron can stain the teeth; therefore, thorough brushing is needed. Ferrous sulfate causes constipation, so the parents should encourage high-fiber foods to reduce the risk. Iron is best absorbed in an acidic environment, so giving the drug with a citrus juice is appropriate. The drug should not be given with milk, eggs, coffee, or tea. The liquid form should be mixed with water or juice to mask the taste and prevent staining of the teeth.

A young school-age child who is being treated for cancer has constipation and loss of appetite. What nursing interventions should the nurse suggest to the family? Select all that apply. -Provide adequate private time in the bathroom. -Use a rectal suppository at the same time each day. -Add high-fiber snacks such as popcorn and washed apples to the diet. -Increase gross motor activities such as family walks.

-Add high-fiber snacks such as popcorn and washed apples to the diet. -Increase gross motor activities such as family walks. -Provide adequate private time in the bathroom. Explanation: Fiber in the diet promotes bowel emptying. Even with decreased appetite, popcorn and apples are likely to be accepted. During chemotherapy, the nurse should be sure all fruits and vegetables are well washed. A simple gross motor activity such as walking stimulates peristalsis. Adequate private bathroom time will promote evacuation in the school-age child who is sensitive about bodily functions. Suppositories are avoided to prevent damage to the rectal mucosa.

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. 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 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. -Administering analgesics -Administering oxygen -Promoting exercise and activity -Administering platelets -Maintaining fluid intake

-Administering oxygen -Administering analgesics -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.

The nurse is caring for clients receiving anticoagulant therapy for embolism prevention. Which factors are a part of the intrinsic pathway for coagulation? Select all that apply. -Hageman factor -Stable factor -Christmas factor -Antihemophilic factor -Stuart factor

-Antihemophilic factor -Christmas factor -Hageman factor Explanation: Effective blood coagulation depends on a complex series of events including a combination of blood and tissue factors released from the plasma (the intrinsic pathway) and from injured tissue (the extrinsic pathway). The plasma-released factors are factors VIII, IX, and XII. Factors released from injured tissues are a tissue factor (an incomplete thromboplastin or factor III), plus factors VII and X.

The nurse is providing care to an adolescent who has been diagnosed with cancer. Which actions would be appropriate for the nurse to take to foster the adolescent's ability to cope? Select all that apply. -Encourage the adolescent to make plans for the future. -Act as an advisor, not a friend, to promote cooperation in the care plan. -Control the amount of information given to others about the adolescent's condition. -Encourage the adolescent to engage in usual activities. -Encouraging postponing the return to school for as long as possible. -Discourage relationships with other adolescents who have cancer

-Encourage the adolescent to engage in usual activities. -Encourage the adolescent to make plans for the future. -Control the amount of information given to others about the adolescent's condition. Explanation: The nurse should encourage usual activities and plans for the future and control the amount of information outsiders know about the child's condition. Relationships with other clients with cancer should be encouraged as well as an early return to school. The nurse should be a friend as well as an advisor to the adolescent.

The nurse has been asked to participate in a community health teaching session. Which interventions would the nurse include to help achieve the 2030 National Health Goals to reduce the incidence of anemias? Select all that apply. -Explain the importance of healthy eating for adolescent participants. -Examine strategies for elderly community members to improve the quality of life. -Instruct pregnant women to take iron supplementation as prescribed. -Emphasize ways to reduce unintentional injuries at home, work, and play. -Review foods that are rich in iron that should be a part of a school-age child's diet.

-Explain the importance of healthy eating for adolescent participants. -Instruct pregnant women to take iron supplementation as prescribed. -Review foods that are rich in iron that should be a part of a school-age child's diet. Explanation: Nurses can help the nation achieve the 2030 National Health Goals to improve children's health and reduce hospitalization from anemia by educating parents about the importance of women taking an iron supplement during pregnancy, encouraging iron-rich food sources for young children, and educating adolescents about healthy diets. Prevention of unintentional injuries and improving the quality of life for the elderly are not interventions to achieve this National Health Goal.

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. -Provide various soft and bland foods to minimize further irritation. -Have the child rinse the mouth with lukewarm water three times a day. -Give the child acidic foods (e.g., orange juice) to cleanse the mouth. -Apply a lip balm or petroleum jelly to prevent cracking. -Vigorously rub the child's gums with gauze to clean them.

-Provide various soft and bland foods to minimize further irritation. -Have the child rinse the mouth with lukewarm water three times a day. -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.

The nurse begins administering blood to a pediatric client with hemoglobinopathy. During the transfusion, the nurse notes: a rash on the child's chest, face, and extremities; temperature 101.8°F (38.8°C); respirations 34 breaths/minute; and the child reports nausea. Which actions will the nurse take? Select all that apply. -Stop the blood transfusion. -Monitor the child's urine output. -Assess the child's vital signs. -Call the child's primary health care provider. -Administer only IV normal saline (NS).

-Stop the blood transfusion. -Administer only IV normal saline (NS). -Assess the child's vital signs. -Monitor the child's urine output. -Call the child's primary health care provider. Explanation: Based on the findings, the nurse would suspect an adverse reaction to the blood transfusion. The nurse would immediately stop the transfusion, administer NS IV to the client, send the blood and tubing to the laboratory, and notify the health care provider. The nurse would continue to monitor the child by assessing vital signs and monitor urine output as a decrease in kidney function could indicate acute kidney failure.

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. -Expect menstrual bleeding to be heavy. -Occasional skipped periods can be expected.

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.

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? -2.5 -1.5 -1.0 -2.0

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 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? -15 mg -6 mg -10 mg -12 mg

10 mg Explanation: The recommended daily dietary iron intake for children 1 to 10 years of age is 10 mg. The recommended daily dietary iron intake for children 0 to 6 months of age is 6 mg. The recommended daily dietary iron intake for boys 11 to 18 years of age is 12 mg. The recommended daily dietary iron intake for girls 11 to 18 years of age is 15 mg.

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? -11.0 to 13.0 seconds -16.0 to 18.0 seconds -6.0 to 9.0 seconds -21.0 to 35.0 seconds

11.0 to 13.0 seconds Explanation: The nurse would identify a prothrombin time of 11.0 to 13.0 seconds as normal for a healthy child. A result of 21.0 to 35.0 seconds would be the expected range for partial thromboplastin time and activated partial thromboplastin time. Findings of 6.0 to 9.0 seconds and 16.0 to 18.0 seconds are outside the normal range.

When reviewing information about the incidence of the various types of childhood cancer, nursing students demonstrate understanding of the information when they identify which type as having the highest incidence? -Neuroblastoma -Non-Hodgkin lymphoma -Acute lymphoblastic leukemia (ALL) -Osteogenic sarcoma

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

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

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.

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

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

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.

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? -Encouraging fluid intake to increase radionuclide uptake. -Advising the physician that the child is allergic to shellfish. -Applying EMLA to the injection site prior to inserting the IV. -Administering a sedative as ordered to keep the child still.

Administering a sedative as ordered to keep the child still. Explanation: The nurse would expect to administer a sedative as ordered to keep the child still because the machine makes a loud thumping noise that could frighten the child. The child must lie without moving while the MRI is being done. Encouraging fluid intake to increase radionuclide uptake is necessary for a bone scan. Advising the physician that the child is allergic to shellfish is an intervention for a computed tomograph (CT) scan with contrast. If the child did not have an IV prior to the MRI and contrast was going to be used, then an IV would need to be inserted for the contrast after the noncontrast MRI was finished. Applying EMLA to an injection site prior to inserting an IV would be appropriate for both the CT and bone scans.

A 9-year-old boy will be undergoing a hematopoietic stem cell transplantation, with donor cells being provided by his 12-year-old sister. The nurse recognizes that this type of transplantation is: -Syngeneic -Autologous -Allogeneic -Heterologous

Allogeneic Explanation: Stem cell transplantation can be allogeneic, syngeneic, or autologous. Allogeneic transplantation is the transfer of stem cells from an immune-compatible (histocompatible) donor, usually a sibling, or from a national cord blood bank or national volunteer donor registry. Syngeneic transplantation (rare) involves a donor and recipient who are genetically identical (are identical twins). Autologous transplantation involves use of the child's own stem cells removed from cord blood banked at the time of the child's birth. Heterologous is not a type of stem cell transplantation.

The nurse is preparing to send a child with cancer for a radiation treatment. Which medication should the nurse provide to premedicate the child for this procedure? -Analgesic -Antipyretic -Antiemetic -Antineoplastic

Antiemetic Explanation: Radiation has systemic effects. Radiation sickness that includes nausea and vomiting is the most frequently encountered systemic effect. It also occurs to some extent as a result of the release of toxic substances from destroyed tumor cells. To counteract this, a child is prescribed an antiemetic before each procedure. The child does not need an analgesic, antipyretic, or antineoplastic agent prior to receiving a radiation treatment.

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

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.

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. -Assessing the child's level of consciousness. -Having the child talk to another child who has had this surgery. -Providing a tour of the intensive care unit.

Assessing the child's level of consciousness. Explanation: The priority intervention is to monitor for increases in intracranial pressure because brain tumors may block cerebral fluid flow or cause edema in the brain. A change in the level of consciousness is just one of several subtle changes that can occur indicating a change in intracranial pressure. Lower priority interventions include providing a tour of the ICU to prepare the child and parents for after the surgery, and educating the child and parents about shunts.

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

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.

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

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

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

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

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.

The father of an 8-year-old boy who is receiving radiation therapy is upset that his son has to go through 6 weeks of treatments. He doesn't understand why it takes so long. In explaining the need for radiation over such a long time, what should the nurse mention? -Cells are only susceptible to treatment by radiation during certain phases of the cell cycle -Radiation therapy is very weak, and therefore it takes a long time to achieve therapeutic doses -It is difficult to locate where the cancer cells are in the body, so the entire body must be irradiated -Insurance companies typically allow only a short radiation treatment per week, to contain costs

Cells are only susceptible to treatment by radiation during certain phases of the cell cycle Explanation: Radiation is not effective on cells that have a low oxygen content (a proportion of cells in every tumor), nor is it effective at the time of cell division (mitosis). Therefore, radiation schedules are designed so that therapy occurs over a period of 1 to 6 weeks and includes time intervals when cells will be in a susceptible stage.

A nursing student compares and contrasts childhood and adult cancers. Which statement does so accurately? -Little is known regarding cancer prevention in adults, although much prevention information is available for children. -Environmental and lifestyle influences in children are strong, unlike those in adults. -Adult cancers are more responsive to treatment than are those in children. -Children's cancers, unlike those of adults, often are detected accidentally, not through screening.

Children's cancers, unlike those of adults, often are detected accidentally, not through screening. Explanation: Children's cancers are often found during a routine checkup, following an injury, or when symptoms appear—not through screening procedures or other specific detection practices. A very small percentage of children may be followed closely because they are known to be at high risk genetically. Most children's cancers are highly responsive to therapy. Few prevention strategies are available for children, although many are known to be effective for adults. Several lifestyle and environmental influences regarding children's cancers are suspect, but few have been scientifically documented. The reverse is true in the adult population.

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

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

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? -Have a Child Life specialist work with the adolescent. -Encourage the adolescent to select hats or wigs to fit one's personality. -Support the adolescent's choice of comfortable clothing. -Refer the adolescent to a peer support group.

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 nurse is instructing the parents of a child with sickle cell anemia on safety precautions. What should the nurse emphasize during this teaching? -Ensure a consistent and daily intake of adequate fluids to prevent dehydration. -Suggest the child participate in sports activities without restriction. -Remind parents that the child should avoid immunizations to prevent the introduction of bacteria into the body. -Treat upper respiratory infections with over-the-counter medication.

Ensure a consistent and daily intake of adequate fluids to prevent dehydration. Explanation: Safety interventions for the child with sickle cell anemia include ensuring an adequate daily intake of fluids to prevent dehydration. Dehydration will precipitate a crisis, which can be avoided. The child should avoid contact sports and long-distance running. Upper respiratory infections should be reported to the health care provider so appropriate treatment can be provided. Routine health care such as immunizations should be provided in order to prevent common childhood illnesses.

A toddler who is beginning to walk has fallen and hit his head on the corner of a low table. The caregiver has been unable to stop the bleeding and brings the child to the pediatric clinic. The nurse is gathering data during the admission process and notes several bruises and swollen joints. A diagnosis of hemophilia is confirmed. This child most likely has a deficiency of which blood factor? -Factor X -Factor V -Factor VIII -Factor XIII

Factor VIII Explanation: The most common types of hemophilia are factor VIII deficiency and factor IX deficiency, which are inherited as sex-linked recessive traits, with transmission to male offspring by carrier females.

A toddler who is beginning to walk has fallen and hit his head on the corner of a low table. The caregiver has been unable to stop the bleeding and brings the child to the pediatric clinic. The nurse is gathering data during the admission process and notes several bruises and swollen joints. A diagnosis of hemophilia is confirmed. This child most likely has a deficiency of which blood factor? -Factor X -Factor VIII -Factor XIII -Factor V

Factor VIII Explanation: The most common types of hemophilia are factor VIII deficiency and factor IX deficiency, which are inherited as sex-linked recessive traits, with transmission to male offspring by carrier females.

A high school football player has been diagnosed as having osteosarcoma of the femur. The parents are angry because they told their adolescent not to play football. Which health teaching points will the nurse include in the teaching plan for the adolescent and parents? -Osteosarcoma often follows trauma, such as a football injury. -Tumor growth is related to the adolescent's dislike of milk. -There will be some discoloration of the leg following chemotherapy. -Football injuries do not contribute to the development of a tumor.

Football injuries do not contribute to the development of a tumor. Explanation: Osteosarcoma is the most malignant form of bone cancer. It is caused by the embryonic mesenchymal tissue that forms in the bones. A football injury may predispose more scrutiny of a lesion, but it will not be the cause of the cancer, nor will the dislike of milk. Osteosarcoma may be treated with chemotherapy and radiation. It may also involve an amputation. The parents who state they are angry at their adolescent for playing football are more likely projecting their fears of the diagnosis and it what it means for their child's future.

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

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.

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? -Have the parent bring the child to the pediatric oncology clinic as soon as possible. -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. -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. Explanation: The preschool-age child is considered immunosuppressed following recent chemotherapy. A fever can mean sepsis, which would require immediate investigation of blood and other body fluids to identify the organism, plus prompt treatment with an IV antibiotic. This can be accomplished only by seeing the pediatric oncologist and is likely to result in hospitalization. The other responses may be implemented after the child arrives at the clinic.

A nurse is preparing a 7-year-old girl for bone marrow aspiration. Which site should she prepare? -Iliac crest -Sternum -Anterior tibia -Femur

Iliac crest Explanation: Bone marrow aspiration provides samples of bone marrow so the type and quantity of cells being produced can be determined. In children, the aspiration sites used are the iliac crests or spines (rather than the sternum, which is commonly used in adults) because performing the test at these sites is usually less frightening for children; these sites also have the largest marrow compartments during childhood. In neonates, the anterior tibia can be used as an additional site.

Which site is most frequently used to perform a bone marrow aspiration? -Humerus -Iliac crest -Rib cage -Femur

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.

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

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

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.

Which nursing diagnosis would be most appropriate for a child with idiopathic thrombocytopenic purpura? -Ineffective breathing pattern related to decreased white blood count -Risk for infection related to abnormal immune system -Risk for altered urinary elimination related to kidney impairment -Ineffective tissue perfusion related to poor platelet formation

Ineffective tissue perfusion related to poor platelet formation Explanation: Idiopathic thrombocytopenic purpura (ITP) results from an immune response following a viral infection that produces antiplatelet antibodies. These antibodies destroy the platelets which cause petechiae, purpura, and excessive bleeding. ITP does not affect the kidneys. Breathing difficulties would not occur with decreased white blood cells. It occurs when there is decreased red blood cells. The child who develops ITP has no different immune system than other children who are healthy.

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? -Fluid overload -Infection -Pallor -Respiratory distress

Infection Explanation: Factors that may precipitate a sickle cell crisis include: fever, infection, dehydration, hot or humid environment, cold air or water temperature, high altitude, or excessive physical activity. Respiratory distress and pallor are general signs and symptoms of a sickle cell crisis.

A school-aged child with cancer is receiving chemotherapy. Which nursing action would best promote the oral comfort of a child receiving chemotherapy? -Vigorously brushing the teeth and gums to remove secretions -Encouraging the use of acidic fruit juices to decrease mouth organisms -Keeping the child's lips moist with petroleum jelly to prohibit cracking -Having the child solely eat or drink cold foods to reduce mucosal pain

Keeping the child's lips moist with petroleum jelly to prohibit cracking Explanation: The mouth of a child receiving chemotherapy can become very inflamed and painful. It is important for the nurse to assess the oral cavity for redness, lesions, and plaques frequently. If the child is NPO, ice chips can be used to provide hydration to the mucosa. It is important to use a soft-bristle toothbrush when brushing the teeth. Excessive pressure on the gums will cause bleeding. If the gums are very inflamed, the child may use a saltwater solution or commercial mouthwash to keep the mouth clean. Instruct the child that this may cause burning. If burning or stinging occurs then discontinue the practice and provide solutions with pain medication. Using a petroleum product on the lips will provide hydration to the lips and keep them from being irritated or cracking. Drinking cold or hot foods will cause more pain in the mouth and may cause further irritation. Acidic fruit juices will cause increased pain and irritation in the mouth and may cause more inflammation.

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

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.

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

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

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.

The nurse is assessing a 3-year-old boy whose mother reports that he is listless and has been having trouble swallowing. Which finding suggests the child may have a brain tumor? -Vital signs show blood pressure measures 120/80 mm Hg. -Examination shows temperature of 101.4° F (38.6°C) and headache. -Observation reveals nystagmus and head tilt. -Observation reveals a cough and labored breathing.

Observation reveals nystagmus and head tilt. Explanation: Coupled with the mother's reports, observation of nystagmus and head tilt suggest the child may have a brain tumor. Elevated blood pressure of 120/80 mm Hg may be indicative of Wilms tumor. Fever and headaches are common symptoms of acute lymphoblastic leukemia. A cough and labored breathing points to rhabdomyosarcoma near the child's airway.

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

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.

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

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 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 -Prepare to administer factor replacement medication -Assess the client's urine and stool for blood -Notify the client's primary health care provider

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.

A child is undergoing a series of diagnostic tests for a suspected malignancy. Which diagnostic test result is only present in Hodgkin disease? -T-lymphocyte surface markers -Reed-Sternberg cells -megakaryocyte cells -elevated lymphocytes

Reed-Sternberg cells Explanation: With Hodgkin disease, lymphocytes proliferate in the lymph glands, and special Reed-Sternberg cells (large, multinucleated cells that are probably nonfunctioning monocyte-macrophage cells) develop. Although these lymphocytes are capable of DNA synthesis and mitotic division, they are abnormal because they lack both B- and T-lymphocyte surface markers and cannot produce immunoglobulins as do usual B-lymphocytes. There will be elevated lymphocytes, but this is present in leukemias as well. T-lymphocyte surface markers are lacking in Hodgkin disease. Megakaryocyte cells are normal cells in the bone marrow and produce platelets.

The nurse is talking with a 9-year-old child diagnosed with acute leukemia who will soon begin chemotherapy. The child expresses worry that when her hair falls out friends won't like her or want to play with her anymore. Which response by the nurse would be best? -Tell the child that having chemotherapy is the only way she'll get better. -Reassure the child that her hair will grow back in 3 to 6 months. -Talk with her and her family about wearing a wig, cap, or scarf. -Distract the child with a book or educational computer games.

Talk with her and her family about wearing a wig, cap, or scarf. Explanation: The child undergoing chemotherapy may want to wear a wig, especially when returning to school. Encourage the family to choose the wig before chemotherapy is started so that it matches the child's hair and the child has time to get used to it. A cap or scarf often is appealing to a child, particularly if it carries a special meaning for him or her. The hair will most likely grow back, chemotherapy is necessary, and distraction can decrease the anxiety, but these are not the best responses for this child.

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

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 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? -Kawasaki disease -Sickle cell disease -Thalassemia -Hemophilia

Thalassemia Explanation: In the child with thalassemia the skin may appear bronze-colored or jaundiced. The child with hemophilia may have bruised areas on the skin. The skin color in children with sickle cell disease may be pale in color, and with Kawasaki disease the child may have a rash on the trunk and extremities.

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? -The child is being prepared for packed red blood cell administration. -The child has mild to moderate iron deficiency. -The child has severe iron deficiency. -The child requires a prophylactic dose of iron.

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.

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

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

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? -Equal pupillary response -Widely fluctuating blood pressure -Petechiae -Hematuria

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? -rectal suppository use -abdominal palpation -fiber intake -aspirin administration

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 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" -administering the measles, mumps, rubella (MMR) vaccine -teaching the importance of taking water safety measures -plotting height and weight on a growth chart

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.

What would the nurse expect to be ordered for a child with acute lymphoblastic leukemia who develops tumor lysis syndrome? -leukapheresis -dexamethasone -allopurinol -inotropics

allopurinol Explanation: Allopurinol is used to prevent and treat tumor lysis syndrome. For prevention, the drug is given for several days prior to chemotherapy. Inotropics would be used to treat sepsis. Leukapheresis would be used to treat leukemia with a high white blood cell count. Dexamethasone would be used to treat spinal cord compression and/or increased intracranial pressure secondary to the tumor or metastasis.

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? -sudden onset of knee pain -nausea and vomiting -bleeding from intravenous sites -blurred vision

bleeding from intravenous sites Explanation: Disseminated intravascular coagulation (DIC) is an acquired disorder of blood clotting that results from excessive trauma. The child begins to develop petechiae or have uncontrolled bleeding from puncture sites from injections or intravenous therapy. Blurred vision, nausea, vomiting, and a sudden onset of knee pain are not manifestations associated with DIC.

Which mechanism is central to cancers in children? -cellular growth -genetics -environment -race

cellular growth Explanation: Certain pediatric malignancies clearly occur at times of peak physical growth and cellular maturation. This coincidence suggests that cellular growth and development are central to the mechanism of cancer in children. By contrast, environmental exposures are a primary component of carcinogenesis in adults. Genetics and race are not commonly identified as related to pediatric cancers.

The nurse is caring for a child admitted with suspected leukemia. The nurse has taken the child's history and performed an assessment. The nurse will plan to prepare the child for which additional diagnostic test first? -complete blood cell count (CBC) -bone marrow aspiration -urinalysis -magnetic resonance imaging (MRI)

complete blood cell count (CBC) Explanation: After obtaining the child's history and symptoms, the nurse would prepare the child for laboratory blood studies to assess the child's white blood cell (WBC) count. A complete blood cell (CBC) count will provide data on the child's WBC level. A bone marrow aspiration would be scheduled based on the results of the CBC as it is required to confirm the diagnosis of leukemia. A urinalysis is done for many disorders. In regard to childhood cancers, it is done to assist assessment for neuroblastoma. MRIs can also be done for many disorders. Brain tumors are common childhood cancers where MRIs are used.

The nurse is caring for an 18-month-old client with suspected iron-deficiency anemia. The nurse will expect to prepare the client for which laboratory tests first? -complete blood count and iron level -iron and thrombocyte levels -ferritin and glycosylated hemoglobin levels -hemoglobin and white blood cell levels

complete blood count and iron level Explanation: The nurse would expect the client to undergo a complete blood count, hemoglobin, hematocrit, reticulocyte, iron, ferritin, and free erythrocyte protoporphyrin levels to confirm the diagnosis. Laboratory evaluation will reveal decreased hemoglobin and hematocrit, decreased reticulocyte count, microcytosis, and hypochromia, decreased serum iron and ferritin levels, and increased FEP level. The other findings do not point to iron-deficiency anemia. A white blood cell is used to diagnosis infection. A thrombocyte level is used to assess platelet counts. Glycosylated hemoglobin levels are used to assess glucose levels over the past 2 to 3 months.

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? -iron-deficiency anemia -von Willebrand disease -disseminated intravascular coagulation -hemophilia

disseminated intravascular coagulation Explanation: Disseminated intravascular coagulation (DIC) is an acquired coagulopathy that, paradoxically, is characterized by both thrombosis and hemorrhage. The outcome for this client is: The child will maintain adequate tissue perfusion of all body systems affected by DIC and regain adequate laboratory values for hemostasis. von Willebrand disease and hemophilia involve hemorrhage but not thrombosis. Iron deficiency anemia does not involve either hemorrhage or thrombosis.

While inspecting the skin of a child, the nurse notes blotchy areas of hemorrhage. When notifying the health care provider, the nurse would identify the client's skin as having: -petechiae. -hematomas. -ecchymoses. -purpura.

ecchymoses. Explanation: Blotchy areas of hemorrhage in the skin are ecchymoses and suggest a vascular disorder. Petechiae are small reddish purplish spots (macules) appearing on the skin. Purpura is purplish or reddish-brown discoloration easily visible through the epidermis; it includes petechiae, ecchymoses, and hematomas. A hematoma is a localized collection of blood creating an elevated ecchymosis.

A child is sent to pediatric intensive care following surgery for a brain tumor. Which prescription would the nurse question? -phenytoin -position on nonsurgical side -elevate head of bed 90 degrees -docusate sodium

elevate head of bed 90 degrees Explanation: An anticonvulsant such as phenytoin will be prescribed if the child is experiencing seizures or if surgery is apt to induce seizures. A child will usually receive a stool softener such as docusate sodium to prevent straining with bowel movements. In general, a child is positioned on the side opposite the surgical incision. Keep the bed flat or only slightly elevated, again, as prescribed, because this helps to reduce intracranial pressure from accumulation of fluid in the surgical area. Therefore, the nurse would need to question the prescription to elevate the head of bed 90 degrees.

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

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.

When planning the care for a child with leukemia who is receiving methotrexate, the nurse would assess the child closely for which possible effect? -mucositis -weight gain -cushingoid facial appearance -paresthesias of the fingers

mucositis Explanation: Mucositis, or ulcers of the gum line and mucous membranes of the mouth, is a frequent side effect of methotrexate. Cushingoid facial appearance and weight gain are associated with the use of prednisone. Paresthesias are associated with vincristine.

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

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 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? -nystagmus, ataxia, and seizures -headache, vision changes, and vomiting -headache, epistaxis, and dizziness -projectile vomiting, lethargy, and coma

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 is scheduled for chemotherapy as treatment for leukemia. As the nurse is collaborating with another colleague, the discussion turns to the client's first phase of chemotherapy. This phase is known as: -delayed intensive therapy. -sanctuary. -maintenance. -induction.

induction. Explanation: A chemotherapy program is aimed at first achieving a complete remission or absence of leukemia cells (induction phase); second, preventing leukemia cells from invading or growing in the CNS (sanctuary or consolidation phase); third, administering delayed intensive therapy; and fourth, maintaining the original remission (maintenance phase).

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

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.

Children with acute lymphoblastic leukemia (ALL) may need periodic lumbar punctures. The nurse would teach the parent that this is done to assess for: -early development of septicemia. -early meningitis. -platelets. -leukemic cells.

leukemic cells. Explanation: Acute lymphoblastic leukemia (ALL) is a rapidly progressive cancer affecting the undifferentiated or immature cells. It is the most common form of cancer in children. Throughout the course of the disease and treatment the child will be tested regularly for complete blood counts, bone marrow aspirations, lumbar punctures, and testing for renal and liver function. Lumbar punctures are performed to determine if leukemic cells have infiltrated the central nervous system. The white blood cells, temperature, and other symptoms would be indicative of meningitis and septicemia. The platelet count would be assessed for the possibility of bleeding.

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)? -platelet count of 250,000 -macrocytic red blood cells (RBCs) -hemoglobin (Hgb) of 11.2 g/dl (112 g/L) -decreased white blood cells (WBCs)

macrocytic red blood cells (RBCs) Explanation: When the MCV is elevated, the RBCs are larger and referred to as macrocytic. The WBC count does not affect the MCV. The platelet count and Hgb are within normal ranges for a 7-year-old child.

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: -osteosarcoma. -leukemia. -neuroblastoma. -Hodgkin disease.

neuroblastoma. Explanation: A 24-hour urine specimen for catecholamines (homovanillic acid [HVA] and vanillylmandelic acid [VMA]) is used to help diagnose neuroblastoma because this cancer produces catecholamines; thus, levels will be elevated. This test is not used to diagnose Hodgkin disease, leukemia, or osteosarcoma.

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? -anorexia -weight loss -painless, enlarged lymph node -night sweats

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.

A 3-year-old boy has been brought to the doctor's office with symptoms of anorexia and abdominal pain. A blood test reveals a lead level of 20 μg/100 mL. The child is prescribed an oral chelating agent. On discharge, the nurse should counsel the parents regarding: -placing house plants out of reach of children. -removal or covering of flaking paint on the walls of the home. -putting medicine away where children cannot reach it. -putting child safety locks on kitchen cabinets.

removal or covering of flaking paint on the walls of the home. Explanation: The usual sources of ingested lead are paint chips or paint dust, home-glazed pottery, or fumes from burning or swallowed batteries. A child with a blood lead level over 5 μg/dl needs to be rescreened to confirm the level and then active interventions begun to prevent further lead exposure, such as removal of the child from the environment containing the lead source or removal of the source of lead from the child's environment. Removal of the lead source is not an easy task in homes because simple repainting or wallpapering does not necessarily remove the source of peeling paint adequately. After some months, the new paint will begin to peel because of the defective paint underneath. The walls must therefore be covered by paneling or drywall or other solid protective material.

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

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

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 oncology nurse is alert for clients displaying signs and symptoms of disseminated intravascular coagulation (DIC). Which symptom would alert the nurse to this emergency condition? -uncontrolled bleeding -platelet count 10,000/mm3 (10 ×109/L) -decreased D-dimer assay -increased antithrombin III levels

uncontrolled bleeding Explanation: DIC is a complex condition that is secondary to other problems such as sepsis. It is life-threatening. Symptoms of DIC include uncontrolled bleeding, petechiae, ecchymosis, purpuric rash, prolonged prothrombin time and partial thromboplastin time, an increased D-dimer assay, decreased antithrombin III levels, below-normal fibrinogen levels, and increased fibrin-degradation products. The platelet count is decreased in DIC. In moderate to severe cases it is less than 50,000/mm3 (50 ×109/L). The symptom the nurse would see first is uncontrolled bleeding. The remainder are laboratory results that would be used to make the diagnosis.

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? -acute blood loss -iron deficiency -sickle-cell disorder -vitamin B12 deficiency

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.

While assessing an adolescent, the nurse notes pallor and a beefy red tongue. Upon questioning, the adolescent reports eating a vegetarian diet to help with weight loss. Which health care provider prescription will the nurse anticipate? -vitamin B12 injections -ferrous sulfate daily -hydroxyurea orally -folic acid supplement

vitamin B12 injections Explanation: Children with pernicious anemia have a vitamin B12 deficiency and have symptoms such as pallor, irritability, beefy red tongue, and diarrhea. Children with iron-deficiency anemia require ferrous sulfate. Folic acid is needed for children with macrocytic anemia. Hydroxyurea could be prescribed for a child with sickle cell anemia.

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 -disseminated intravascular coagulation (DIC) -von Willebrand disease (vWD) -chronic iron deficiency anemia

von Willebrand disease (vWD) Explanation: The primary clinical manifestations of vWD are bruising and mucous membrane bleeding from the nose, mouth, and gastrointestinal tract. Bleeding associated with vWD may be severe and lead to anemia and shock, but deep bleeding into joints and muscles, like that seen in hemophilia, is rare except with type III vWD.