Archer Child Health - Hematological/Oncological

The nurse is caring for a child with nephroblastoma. The nurse plans to take which action? A. Post a sign that states, "Do not palpate abdomen" B. Recommend foods low in protein C. Insert an indwelling urinary catheter D. Initiate fluid restrictions Submit Answer

Explanation Choice A is correct. Nephroblastoma (Wilms tumor) is the most common childhood cancer. Common treatments include surgical removal followed by chemotherapy. Nursing care involves minimal manipulation of the abdomen (no palpation) and a posted sign. It is essential to keep the encapsulated tumor intact. Choices B, C, and D are incorrect. These are not interventions relevant to a client with nephroblastoma; instead, these may be used for acute or chronic renal disease. While nephroblastoma may impair renal function, this is not commonly seen. Additional Info Nephroblastoma is a tumor affecting the kidney(s). The average age at diagnosis is three years in children with single kidney disease. It is slightly younger for those with bilateral involvement. Nephroblastoma nursing care involves Frequent blood pressure monitoring because this tumor may induce renin-related hypertension Avoid any activities that may cause palpation to the abdomen Gastrointestinal assessment as obstruction may consequently occur (absent bowel sounds, abdominal distention should be reported) Assessment of hemorrhage (tachycardia and hypotension) Last Updated - 09, Nov 2022

A 10-year-old client was diagnosed with hemophilia. Which blood study is characteristically abnormal in this condition? A. PTT (partial thromboplastin time) B. Thrombocyte count C. Complete blood count D. Platelet count Submit Answer

Explanation Choice A is correct. PTT (partial thromboplastin time) is commonly used in clinical practice for various reasons, including as part of a "coagulation panel" to help elucidate potential causes of bleeding or clotting disorders. Clients with a propensity for bleeding should undergo testing to determine the presence of a clotting disorder. For clients with deficiencies or defects of the intrinsic clotting cascade (including hemophilia clients), the client's PTT (partial thromboplastin time) result is typically elevated. Choice B is incorrect. Thrombocyte counts typically remain normal in hemophilia clients. Choice C is incorrect. A client's complete blood count is not usually affected by hemophilia. Choice D is incorrect. In hemophilia clients, the client's platelet count is typically normal. Learning Objective Recognize that a prolongation of the PTT (partial thromboplastin time) blood study is characteristic in clients with hemophilia. Additional Info Hemophilias are hereditary bleeding disorders caused by deficiencies of either clotting factor VIII or IX. The extent of factor deficiency determines the probability and severity of bleeding. Bleeding into deep tissues or joints usually develops within hours of trauma. Hemophilia is an inherited disorder that results from mutations, deletions, or inversions affecting the factor VIII or factor IX gene. Because these genes are located on the X chromosome, hemophilia affects males almost exclusively. Last Updated - 29, Jan 2023

A nurse is assigned to care for a 2-year-old newly diagnosed with acute lymphocytic leukemia. Which of the following would the nurse prioritize in the client's plan of care to facilitate growth and development in the acutely ill toddler? A. Focus on educating the parents to minimize anxiety. B. Ensure that the toddler is informed beforehand of what will occur during a procedure. C. Isolate the child from parents, especially if there are temper tantrums. D. Encourage regression to a previous developmental level for familiarity and comfort. Submit Answer

Explanation Choice A is correct. When a toddler is acutely ill, it is best to have parents (or caregivers) who are not overly anxious, as an anxious parent or family member will negatively affect the toddler. Here, by focusing on educating the parents of the toddler throughout the duration of the hospitalization, the parents will not only have decreased anxiety levels, but will also likely work more cohesively with medical staff. By removing potential treatment barriers while ensuring that the toddler's parents and healthcare team are united in the treatment goals, the unified focus becomes the toddler's growth and development. Therefore, educating the parents to minimize anxiety should be prioritized in the client's plan of care. Choice B is incorrect. Parents and caregivers play an essential role in helping pediatric clients remain calm throughout the entirety of the hospitalization experience. Although a toddler's thinking is concrete and tangible, and the toddler likely cannot think beyond the observable, the parent(s) or caregiver(s) should still attempt to provide a simple explanation of what procedure will occur, as some toddlers may benefit from a simple explanation on the day of the appointment. Choice C is incorrect. A toddler is both wary of strangers and anxious about the separation from parents. Toddlers are acutely aware of the new hospital environment, with the entire process of hospitalization threatening and difficult. Temper tantrums are a standard developmental characteristic of a 2-year-old, and the parent(s) or caregiver(s) must often hold the toddler to alleviate fear. Isolating the toddler from their parent(s) or caregiver(s) is not therapeutic and should, therefore, be avoided. Choice D is incorrect. Hospitalization is a major stressor for children of every age. With admission, the child's familiar and typically nurturing environment is suddenly lost. Developmental regression is a common response to hospitalization. It involves the loss of developmental milestones during and after hospitalization. Developmental regression is an expected and self-protective response to hospitalization across all age groups, which typically resolves when daily patterns and activities return to normal. Although developmental regression is an expected response occurring in all age groups upon hospitalization, a nurse would never encourage this regression. Learning Objective Identify the need to prioritize educating the parents of a 2-year-old newly diagnosed with acute lymphocytic leukemia to minimize anxiety in the client's plan of care to facilitate growth and development. Additional Info Developmental regression is considered a healthy way for many children to cope with the hospital experience. Children's reactions to medical situations are shaped by many factors, including their personality, developmental stage, style of handling stress in other situations, and experiences with past medical procedures. Research suggests that pediatric clients are more cooperative if their parents or caregivers take measures to reduce their own anxiety. Families can play a significant role in helping a pediatric client prepare for a medical procedure. Last Updated - 19, Jan 2023

The nurse is caring for an adolescent with hemophilia who reports pain and joint bleeding after playing baseball. The nurse should prioritize the client's A. acute pain. B. bleeding. C. self-esteem. D. knowledge deficit. Submit Answer

Explanation Choice B is correct. Addressing the client's active bleeding is the priority, as the client may develop shock if it goes untreated. Bleeding associated with hemophilia is often found in the joint space or at the point of physical injury. Choices A, C, and D are incorrect. Acute pain may be associated with a bleeding episode, but the pain is often brief and is not life-threatening. Chronic illnesses may negatively impact self-esteem, and the nurse should focus only on this aspect once the physical needs have been met. Enhancing the adolescents' knowledge to avoid contact sports is important, but this is not an immediate physical need compared to bleeding. Additional Info Last Updated - 30, Sep 2022

Which of the following medications may be prescribed to control hypertension associated with a nephroblastoma? A. Propranolol B. Enalapril C. Nitroprusside D. Digoxin Submit Answer

Explanation Choice B is correct. Enalapril is an ACE inhibitor used to lower blood pressure. Since patients with nephroblastoma are hypertensive due to increased levels of renin, this medication is commonly prescribed to decrease their blood pressure. Any ACE inhibitor works to reduce blood pressure by inhibiting the formation of angiotensin II in the renin-angiotensin-aldosterone system (RAAS), so they are an excellent choice for treating hypertension caused by nephroblastoma. Choice A is incorrect. Propranolol is a beta-blocker used to slow the heart rate. While it can decrease blood pressure in specific patient populations, it is not prescribed to patients with nephroblastoma to reduce their hypertension. Choice C is incorrect. Nitroprusside is a direct-acting vasodilator. This means it acts on the muscles of your blood vessels to dilate them, therefore lowering the blood pressure. While this drug also lowers blood pressure, it is not the right choice for hypertension associated with nephroblastoma. It does not address the RAAS, which is what causes hypertension in patients with nephroblastoma. Choice D is incorrect. Digoxin is a cardiac glycoside. It increases the force of contraction of the muscle of the heart and is commonly prescribed to patients in heart failure. It would not be administered to patients with a nephroblastoma to lower their blood pressure. NCSBN Client Need: Topic: Physiological Integrity, Subtopic: Pharmacological therapies; Pediatrics - Oncology Last Updated - 05, Jan 2022

The nurse is talking to a group of female teenagers regarding the dangers associated with human papilloma virus. Which cancer mentioned by the group would indicate an understanding of the topic? A. Neuroblastoma B. Cervical cancer C. Osteoblastoma D. Osteosarcoma Submit Answer

Explanation Choice B is correct. The client with HPV has a higher risk for cervical and vaginal cancer. Choice A is incorrect. This type of cancer is not related to exposure to HPV. Choice C is incorrect. This type of cancer is not related to exposure to HPV. Choice D is incorrect. This type of cancer is not related to exposure to HPV. Last Updated - 06, Feb 2022

You are reinforcing counseling for two parents that are preparing for the birth of their first child. The father has sickle cell anemia and the mother is a carrier. You tell them that their baby has what chance of having sickle cell anemia? A. 25% B. 50% C. 75% D. 100% Submit Answer

Explanation Choice B is correct. Their baby has a 50% chance of having sickle cell anemia (ss). The disease chromosome is indicated by lower case "s" whereas the normal chromosome is indicated by an upper case "S". From the information presented in the question, the father is ss because he has the disease and the mother is Ss since she is a carrier. The disease is referred to as sickle cell anemia or sickle cell disease, whereas the carrier state is referred to as sickle cell trait. Sickle cell anemia is inherited in an autosomal recessive pattern, which means that both copies of the gene in each cell should have the mutations to have that disease (ss). The parents of an individual with an autosomal recessive condition such as sickle cell disease must each carry one copy of the mutated gene. The odds/chances of the offspring having the disease or carrier state are determined by the Punnett square. The Punnett square is as follows: Choice A is incorrect. The baby does not have a 25% chance of having sickle cell anemia. Should the mother and father each have the carrier state alone (Ss), the baby would have a 25% chance of having sickle cell anemia/disease. Choice C is incorrect. The baby does not have a 75% chance of having sickle cell anemia. This odds possibility does not happen in an autosomal recessive inheritance with any kind of parental combinations. Choice D is incorrect. The baby does not have a 100% chance of having sickle cell anemia. This can only happen if both parents have sickle cell anemia (ss) but not when one of the parents is a carrier. NCSBN Client Need Topic: Physiological Integrity; Subtopic: Risk potential reduction Last Updated - 19, Dec 2021

A 12-year-old is diagnosed with a vaso-occlusive sickle cell crisis and complains of severe headaches. What should be the nurse's initial intervention? A. Give oxygen at 6 liters per minute via nasal cannula. B. Assess the client's neurologic status. C. Give an intravenous dose of morphine. D. Increase the client's IV rate. Submit Answer

Explanation Choice B is correct. This client with sickle cell crisis has a high risk of cerebrovascular accidents (CVA). Since the client has a severe headache, it is best to rule out a CVA before initiating all other interventions. Choice A is incorrect. Giving oxygen can help reduce the cells' sickling, but this is not the first intervention for the client's headache. Furthermore, oxygen-carrying capacity is reduced when the cells are actively sickling. Increasing oxygen content in the blood will not significantly improve the oxygen-carrying capacity in a non-hypoxemic sickle cell client. There is no indication that the client is hypoxemic. (Note: If the information is absent in the question stem, that vital is considered normal. When evaluating the questions, do not add additional information to the question stems on the NCLEX). Choice C is incorrect. The nurse must first assess to determine whether the pain is from what is expected with the disease process or whether it is a complication. Administering pain medications right away would mask the actual disease process. Choice D is incorrect. Hydration can help in decreasing the sickling of cells. Choice D indicates that IV hydration is already in place. In SCD, the client should be kept euvolemic. Hypervolemia should be avoided because it can cause additional problems that come from fluid overload. Increasing the IV hydration without assessing the volume status is not the first intervention for this client. Last Updated - 13, Jan 2022

Which of the following patients would be considered most at risk for iron-deficiency anemia? A. A 12-year-old female who has not started menses. B. A 30-year-old who is pregnant with her first child. C. A 13-month-old who will only drink cow's milk and is very pale. D. An 8-year-old with a hemoglobin of 13. Submit Answer

Explanation Choice C is correct. 12 to 16-month-olds are at increased risk for iron deficiency anemia. At this age, they no longer have maternal stores of iron left over, they are picky eaters, and often do not consume enough iron in their diet. Cow's milk is not a good source of iron and we know children at this age who only drink cow's milk are at increased risk for iron-deficiency anemia. Also, the question states that the child is very pale, so we suspect iron deficiency anemia may be a problem. Choice A is incorrect. At 12-years-old, this patient is not yet an adolescent and is not in an at-risk group for iron-deficiency anemia. Also, the question states that she has not yet started her menses. When females first start their menses and begin losing a lot of blood, they are at risk for iron deficiency anemia. Choice B is incorrect. Pregnant women are in an at-risk group for iron deficiency anemia, but there is another patient listed in this question who appears more at risk. This woman has no other risk factors and the issue gives no other indications that she may be experiencing iron deficiency anemia. Choice D is incorrect. 8-year-olds are not in an at-risk group for iron deficiency anemia. Also, hemoglobin of 13 is typical for this age group and sufficient for the oxygen-carrying capacity to the tissue. NCSBN Client Need: Topic: Health promotion and maintenance, Subtopic: Pediatrics - Hematology Last Updated - 12, Nov 2021

The nurse is taking vital signs on her patient with a diagnosis of acute lymphoblastic leukemia (ALL). His temperature is 38.7 degrees C. What is the nurse's priority? A. Place cool washcloths on the patient's head. B. Continue with her assessment. C. Obtain intravenous access on the patient. D. Assess the patient's perfusion. Submit Answer

Explanation Choice C is correct. It is the priority action to establish intravenous access for this patient. This patient has a diagnosis of ALL, so the nurse knows that he is immunocompromised. He is very susceptible to infections and with a fever of 38.7 degrees C, she has a high index of suspicion for disease. Broad-spectrum IV antibiotics will need to be started right away. Therefore it is the priority of the nurse to start an IV. Choice A is incorrect. Placing cold washcloths on the patient's head is not the priority; there is a better answer. This would only need to be done if the patient was at risk for seizures due to incredibly high body temperature. The temperature of 38.7 degrees C does not warrant cooling measures and the nurse has another immediate priority given the patient's immunosuppression along with her suspicion of an infection. Choice B is incorrect. It is inappropriate for the nurse to simply continue with her assessment since she suspects an infection in her patient who is immunocompromised. Another answer has an immediate priority that the nurse must do. Choice D is incorrect. Assessing the patient's perfusion has nothing to do with the nurse's suspicion of an infection. She should immediately establish IV access for the administration of antibiotics. NCSBN Client Need: Topic: Effective, safe care environment, Subtopic: Infection control and safety; Pediatrics - Oncology Last Updated - 16, Feb 2022

The nurse is caring for a child with nephroblastoma. To prevent complications from this tumor, the nurse should closely monitor the client's A. liver function tests. B. capillary blood glucose. C. blood pressure. D. visual acuity. Submit Answer

Explanation Choice C is correct. Nephroblastoma is a childhood cancer involving the kidney(s). Hypertension may occur because of the surge in renin triggered by the tumor. Choices A, B, and D are incorrect. Liver function tests may be monitored in the event of metastasis. However, an elevation of LFTs does not conclusively indicate metastasis. Capillary blood glucose and visual acuity are not routinely monitored for nephroblastoma. These two parameters are irrelevant to the condition. Additional Info Nephroblastoma is a tumor affecting the kidney(s). The average age at diagnosis is three years in children with single kidney disease. It is slightly younger for those with bilateral involvement. Nephroblastoma nursing care involves ➢ Frequent blood pressure monitoring because this tumor may induce renin-related hypertension ➢ Avoid any activities that may cause palpation of the abdomen ➢ Gastrointestinal assessment as obstruction may consequently occur (absent bowel sounds, abdominal distention should be reported) ➢ Assessment of hemorrhage (tachycardia and hypotension) Last Updated - 06, Nov 2022

The nurse is assessing a patient diagnosed with stage IV nephroblastoma. Which of the following actions should the nurse not perform in this patient? A. Checking capillary refill B. Auscultating heart sounds C. Abdominal palpation D. Assessing urine color Submit Answer

Explanation Choice C is correct. The nurse should not perform abdominal palpation in a patient with a nephroblastoma (Wilm's tumor). Vigorously palpating the mass can cause the tumor to rupture and bleed into the peritoneal cavity. In patients with early-stage disease, rupture of the tumor may also cause it to spread to other parts of the body. If necessary, the physician may palpate the tumor cautiously. Nephroblastoma develops from immature kidney cells and grows into the peritoneal cavity. It is the 4th most common cancer in children. Nephroblastoma most commonly presents with an asymptomatic, palpable abdominal mass. Other features include hypertension, abdominal pain, microscopic hematuria, and fever. Occasionally, gross hematuria may be present. Long-standing hypertension in nephroblastoma may lead to cardiomyopathy/congestive heart failure. Choice A is incorrect. There is no contraindication for checking the capillary refill in a patient with nephroblastoma. By checking capillary refill, the nurse will be assessing the client's perfusion status, which is important. Choice B is incorrect. There is no contraindication for auscultating heart sounds in the patient with nephroblastoma. In fact, auscultating an S3 heart sound may provide a clue for underlying fluid overload/heart failure in these patients. Nephroblastomas can cause an increase in renin production (hyperreninemia). Elevated renin produces vasoconstriction and fluid retention that leads to hypertension. Sustained hypertension may lead to cardiomyopathy in these patients. Fluid overload must be avoided in patients with nephroblastoma. Choice D is incorrect. Nephroblastoma arises from the kidney. Therefore, hematuria is a common finding in patients with nephroblastoma. Red urine color may suggest gross hematuria. The nurse should assess for adequate urine production and hematuria and report any alarming findings to the healthcare provider. NCSBN Client Need: Topic: Physiological Integrity; Subtopic: Basic care, comfort Last Updated - 06, Feb 2022

An eight-year-old boy diagnosed with hemophilia A is brought into the urgent care clinic for a prolonged episode of hematemesis. Which of the following describes this symptom? A. Bleeding into the joints B. Bleeding from the nose C. Dark, black, tar-like stools D. Bloody vomit Submit Answer

Explanation Choice D is correct. Hematemesis is bloody vomit. This symptom is common with hemophilia and can lead to severe complications if not treated promptly. Choice A is incorrect. Bleeding into the joints is a symptom known as hemarthrosis, not hematemesis. Both of these symptoms are common with hemophilia and can lead to severe complications if not treated promptly. Choice B is incorrect. Bleeding from the nose is a symptom known as epistaxis, not hematemesis. Both of these symptoms are common with hemophilia and can lead to severe complications if not treated promptly. Choice C is incorrect. Dark, black, tar-like stools are known as melena, not hematemesis. Melena stools are indicative of an upper GI bleed, as the blood is dark. Both of these symptoms are common with hemophilia and can lead to severe complications if not treated promptly. NCSBN Client Need: Topic: Physiological Integrity, Subtopic: Physiological adaptation; Pediatrics - Hematology Last Updated - 05, Feb 2022

Which of the following vital sign abnormalities does the nurse know is a clinical manifestation of her patient's Wilms tumor? A. Tachycardia B. Bradypnea C. Hypotension D. Hypertension Submit Answer

Explanation Choice D is correct. Hypertension is a clinical manifestation of Wilms tumor. This tumor is located on the kidneys and causes an increased amount of renin to be present in the patient. Increased renin levels lead to hypertension through sodium and water retention via the RAAS system. Choice A is incorrect. Tachycardia is not a clinical manifestation of Wilms tumor. These patients should have an average heart rate. If tachycardia is observed, it should be reported to the healthcare provider and further evaluated to identify the cause. Choice B is incorrect. Bradypnea is not a clinical manifestation of Wilms tumor. These patients should have a regular respiratory rate. If bradypnea is observed, it should be reported to the healthcare provider and further evaluated to identify the cause. Choice C is incorrect. Hypotension is not a clinical manifestation of Wilms tumor, but hypertension is. This tumor is located on the kidneys and causes an increased amount of renin to be present in the patient. Increased renin levels lead to hypertension through sodium and water retention via the RAAS system, not hypotension. NCSBN Client Need: Topic: Physiological Integrity, Subtopic: Basic care, comfort; Pediatrics - Oncology Additional Info Source : Archer Review Last Updated - 08, Aug 2021

The nurse is taking care of a 9-year-old boy undergoing testing for acute myeloid leukemia (AML). She is assisting with the client's positioning for a lumbar puncture. Which of the following positions is appropriate? A. Prone B. Trendelenburg C. Supine D. Side lying Submit Answer

Explanation Choice D is correct. Side-lying (lateral recumbent) is the most appropriate position for a lumbar puncture (LP). The client's legs are flexed at the knee and pulled towards the chest, while the upper thorax is curved forward in an almost fetal position. A pillow may be placed under the client's head and/or between the legs. This position will allow the health care provider to identify the lumbar vertebrae and insert the needle into the subarachnoid space at the L3-4 or L4-5 interspace. The lateral recumbent position is preferred over the upright position because it allows for accurate measurement of the cerebrospinal fluid (CSF) opening pressure. An upright or sitting position may be used for the LP when the client's lateral position is not feasible. Choice A is incorrect. Placing the patient in the prone position for a bedside lumbar puncture is not appropriate. The prone position is generally preferred for LPs performed under fluoroscopic guidance with the patient lying face down. Prone positioning is also used to increase ventilation and perfusion to the lungs in acute respiratory distress syndrome (ARDS) and in some infants with congenital anomalies such as tracheoesophageal fistula (TEF) that are at risk for aspiration. Choice B is incorrect. Placing the patient in a Trendelenburg position for a lumbar puncture is not appropriate. Trendelenburg refers to a position where the patient is placed supine and then reclined so that the feet are 15-30 degrees above the head. Trendelenburg is used in preterm labor or placing a central venous catheter in the internal jugular or subclavian vein. Choice C is incorrect. The supine position is not appropriate for a lumbar puncture. With a patient lying on the back, the health care provider would not be able to access the intrathecal space to perform the LP. However, the client is instructed to lie supine following the LP since headache is a common complaint after the LP. Post-LP headache occurs due to CSF pressure changes and sitting up soon after the LP can worsen the headache. Therefore, the client is advised to lie flat for 6-12 hours after the LP. NCSBN Client Need:Topic: Physiological Integrity; Subtopic: Basic care, comfort Last Updated - 15, Nov 2022

You are reinforcing counseling for two parents that are preparing for the birth of their first child. The mother has sickle cell anemia. So the father has decided to undergo genetic testing to determine if he is a carrier or not. He finds out that he is not a carrier. You tell them that their baby has what chance of having sickle cell anemia? A. 25% B. 50% C. 75% D. 0% Submit Answer

Explanation Choice D is correct. The baby has no chance, a 0% chance of having sickle cell anemia. Instead, the baby will be a carrier. Since the baby's mother has the disease, she is ss, and because the father has tested that he is not a carrier nor does he have the disease, he is SS. This means that the only combination possible for the baby is Ss (carrier). Choice A is incorrect. The baby does not have a 25% chance of having sickle cell anemia. Choice B is incorrect. The baby does not have a 50% chance of having sickle cell anemia. Choice C is incorrect. The baby does not have a 75% chance of having sickle cell anemia. NCSBN Client Need: Topic: Physiological Integrity, Subtopic: Risk of the potential reduction; Pediatrics - Hematology Last Updated - 15, Nov 2021

Wilms tumor is a cancer most commonly in children under the age of 5. These tumor cells originate from which of the following? A. Lung cells B. Epithelial cells C. Adipose cells D. Renal cells Submit Answer

Explanation Choice D is correct. Wilms tumor, also known as nephroblastoma, is a cancer of the kidneys. It's tumor cells originate from renal cells. Choice A is incorrect. Wilms tumor, also known as nephroblastoma, is a cancer of the kidneys. It's tumor cells do not originate from lung cells. The lungs, however, are the most common location for cancer to metastasize to. Choice B is incorrect. Wilms tumor, also known as nephroblastoma, is a cancer of the kidneys. It's tumor cells do not originate from epithelial, or skin cells. Choice C is incorrect. Wilms tumor, also known as nephroblastoma, is a cancer of the kidneys. It's tumor cells do not originate from adipose, or fat cells. NCSBN Client Need Topic: Physiological Integrity, Subtopic: Basic care, comfort; Pediatrics - Oncology Last Updated - 14, Feb 2022

You are caring for a 4-year-old male presenting with a sickle cell crisis. He scores an eight on the FLACC scale for pain. Other findings are shown in the exhibit. Which of the following nursing interventions are appropriate for the patient? See the exhibit. Select all that apply. View Exhibit A. Administer IV morphine B. Place the patient on 2 liters O2 via a nasal cannula C. Make the patient NPO D. Apply cool washcloths to the forehead Submit Answer

Explanation Choices A and B are correct. Administering IV morphine per the physician's order is an appropriate intervention for a patient experiencing a sickle cell crisis. These patients are experiencing a large amount of pain due to the sickled red blood cells snagging on their vessels and clumping together. Opioids should be administered to address the pain. Your patient is scoring an 8 out of 10 on the FLACC scale, indicating severe pain, so IV morphine is warranted (Choice A). Administering oxygen as needed is an essential practice for sickle cell crises. The sickled red blood cells are not effectively delivering oxygen to the tissues and the patient is desaturated with a SpO2 of 89%. Starting with 2 liters O2 is appropriate (Choice B). Choice C is incorrect. It is not appropriate to make the patient NPO. During a sickle cell crisis, hydration is one of the top priorities. Unless the patient cannot tolerate PO intake, you should encourage them to drink or increase oral hydration. Intravenous fluids may also be necessary. Choice D is incorrect. Using cold washcloths and compresses is contraindicated as cool temperatures can increase sickling and worsen the crisis. Warm compresses are appropriate as a nonpharmacologic intervention for pain control if the patient feels that it helps their pain. NCSBN Client Need: Topic: Physiological Integrity; Subtopic: Basic care, comfort Last Updated - 10, Oct 2021

The nurse is caring for a 3-year-old newly diagnosed with acute lymphoblastic leukemia (ALL). While talking to the family, which of the following educational points does the nurse know to reinforce based on the child's diagnosis? Select all that apply. A. Bleeding precautions B. Contact precautions C. Neutropenic precautions D. Sternal precautions Submit Answer

Explanation Choices A and C are correct. Bleeding precautions are an essential educational point for a patient with ALL. Due to the excess of blast cells, their platelet count will drop. With decreased platelets, it will take the patient longer than usual to clot, leading to an increased bleeding risk (Choice A). Neutropenic precautions are essential to discuss with the family of a child with ALL. Since the child has a low absolute neutrophil count and a high blast percentage, their ability to fight infections will be severely impaired. This means that special precautions need to be in place to protect the child from disease. These neutropenic precautions include no fresh flowers or plants in the room; all visitors should wash their hands before entering the room and wear a mask, no sick visitors, and keep the door closed (Choice C) Choice B is incorrect. Contact precautions are not necessary for a patient with ALL. Contact precautions would be used for a disease that is spread from person to person via contact with the infectious agent, such as MRSA. ALL is not a contagious disease that can be transmitted from person to person, so contact precautions are unnecessary. Choice D is incorrect. Sternal precautions are unnecessary for the patient with ALL. Sternal precautions are put in place after an incision is made on the sternum during cardiothoracic surgery. It is to prevent excessive pulling and tension on these sutures while the sternum heals. The patient with ALL does not need sternal precautions. NCSBN Client Need: Topic: Effective, safe care environment, Subtopic: Infection control and safety; Pediatrics - Oncology Last Updated - 27, Jan 2022

The nurse is caring for a 5-year-old girl diagnosed with hemophilia with a recurrent episode of hemarthrosis. Which of the following would the nurse expect on their assessment? Select all that apply. A. Joint pain and swelling B. Decreased level of consciousness C. Bruising D. Melena Submit Answer

Explanation Choices A and C are correct. Hemarthrosis is defined as bleeding into a joint cavity. Most commonly affected joints include knees, ankles, and elbows. Hemarthrosis is a frequent complication of hemophilia because of the deficiency of clotting factors and prolonged clotting times. When the nurse has a patient with hemarthrosis, she can expect joint pain and swelling, and external bruising in the hemarthrosis area due to the accumulation of blood in that joint cavity. Choice B is incorrect. A decreased level of consciousness (LOC) is not a finding expected with hemarthrosis. Hemarthrosis is defined as bleeding into a joint cavity, which would not cause a decreased LOC. Decreased LOC may be seen in patients with hemophilia if they develop a brain bleed. Other symptoms to look out for if a brain bleed is expected include slurred speech, vision changes, and headaches. Choice D is incorrect. Melena is not a finding expected with hemarthrosis. Hemarthrosis is defined as bleeding into a joint cavity, which would not cause melena. Melena is characterized by black, tarry stools and is due to upper gastrointestinal bleed. Melena is a symptom of hemophilia as well but is not associated with hemarthrosis. NCSBN Client Need: Topic: Physiological Integrity, Subtopic: Physiological adaptation; Pediatrics - Hematology Last Updated - 22, Jan 2022

Which of the following clinical manifestations would alert the nurse to the possibility of Kawasaki's disease in an 8-year-old patient? Select all that apply. A. Strawberry tongue B. Fruity breath C. Drooling D. Bright red, swollen lips Submit Answer

Explanation Choices A and D are correct. Kawasaki's disease is a swelling in the walls of the arteries throughout the body. Due to this inflammation, a strawberry tongue is a common identifying symptom. Other signs and symptoms include a high fever that persists for five or more days, a rash on the torso and groin, bloodshot eyes, bright red, swollen lips, as well as red palms and soles of the feet. Choice B is incorrect. Fruity breath is not a sign of Kawasaki's disease. Fruity breath is characteristic of a child presenting with DKA. Choice C is incorrect. Drooling is not a sign of Kawasaki's disease. Drooling is characteristic of a child presenting with epiglottitis. NCSBN Client Need: Topic: Effective, safe care environment, Subtopic: Coordinated care; Pediatrics Last Updated - 27, Jun 2021

The nurse is discharging an adolescent with sickle cell disease. Which statement should the nurse include in the teaching? Select all that apply. A. Keep a water bottle with you at school so that you can stay hydrated B. Follow a high-calorie, high-protein diet C. Do not take the annual influenza vaccine D. Drink extra fluids if you have to travel on an airplane E. Daily aerobic exercise is recommended Submit Answer

Explanation Choices A, B, D, and E are correct. Remaining hydrated is one of the most important points to stress to the client. A vasocclusive crisis occurs due to dehydration, febrile illness, or significant psychological stress. Avoiding these situations will help avoid a crisis. Following a high-calorie, high-protein diet is necessary to promote optimal nutrition. Supplementation with folic acid may also be needed. Flying on an airplane is generally safe if the client hydrates even more before the flight. Daily aerobic exercise (brisk walks) is allowed as it does support cardiovascular and mental health. It is vigorous exercise that may cause dehydration that should be discouraged. Again, hydration is key before and during exercise. Choice C is incorrect. Individuals with sickle cell disease have lowered immunity due to secondary functional asplenia. Therefore, receiving the annual influenza vaccine is highly recommended. Additional Info Sickle cell disease (SCD) is a genetic disorder that causes abnormalities in hemoglobin. The client has an increased presence of hemoglobin S compared to a decreased hemoglobin A. Vaso-occlusive event (VOE) may be triggered by a client having a decrease in fluid, stress, infection, or use of substances. Nursing care aims to provide appropriate hydration with a combination of hypo- or isotonic fluids, optimal pain control with opioids, and oxygen as clinically indicated. To promote comfort, the nurse should remove constrictive clothing and keep the room temperature warm. Self-management for a client with SCD includes adequate hydration, vaccinations, routine exercise, and annual health examinations. Last Updated - 22, Nov 2022

The LPN is assigned to take care of a patient with hemophilia. When she reviews the lab values, she would expect to find which of the following? Select all that apply. A. Normal PT level B. Abnormal PTT level C. Normal thrombin time D. Abnormal INR Submit Answer

Explanation Choices A, B, and C are correct. A is correct. Patients with hemophilia will have an average PT level, between 11 and 13.5. The Prothrombin time test measures the time necessary to generate fibrin after activation of factor VII. This evaluates the extrinsic pathway: Factors V, X, prothrombin, and fibrinogen. Since patients with hemophilia have deficiencies in factors XIII, IX, or XI depending on their sub-type, this test result will be reasonable. B is correct. Patients with hemophilia will have an abnormal PTT level. The partial thromboplastin time measures the integrity of the intrinsic clotting cascade, evaluating factors XII, XI, VIII, and IX. Since these are the factors in which a deficiency leads to a type of hemophilia, this level will be abnormal in patients with hemophilia. It is prolonged from the regular 25 to 35 seconds, meaning that it takes the blood longer than usual to clot. C is correct. Patients with hemophilia will have a standard thrombin time. Thrombin time assesses how long it takes fibrin to form from fibrinogen in plasma. This is not part of the clotting cascade that patients with hemophilia have a deficiency in, so there is no abnormality. Their value will be reasonable, between 12 and 14 seconds. Choice D is incorrect. The INR, otherwise known as the international normalized ratio, is a value calculated from the PT or prothrombin time. It is often used to monitor patients who are taking warfarin. Patients with hemophilia will have a normal INR because they have a regular PT. NCSBN Client Need: Topic: Physiological Integrity, Subtopic: Coordinated Care; Pediatrics - Hematology Last Updated - 12, Nov 2021

Which of the following assessment findings would you expect for your patient diagnosed with iron deficiency anemia? Select all that apply. A. Tachycardia B. Pica C. Pallor D. Insomnia Submit Answer

Explanation Choices A, B, and C are correct. A is correct. Tachycardia is an expected assessment finding for a patient with iron deficiency anemia. When the patient has decreased oxygen delivery to the tissues, the body increases the heart rate to try to compensate. B is correct. Pica is an expected assessment finding for a patient with iron deficiency anemia. Pica is defined as "a tendency or craving to eat substances other than normal food (such as clay, plaster, or ashes)" This is due to the low iron level in the body. C is correct. Pallor is an expected assessment finding for a patient with iron deficiency anemia. Due to low iron levels, there is decreased oxygen delivery to the tissues and reduced perfusion. This causes pallor and other signs of decreased perfusion. Choice D is incorrect. Insomnia is not an expected assessment finding for iron deficiency anemia. These patients are typically frail and fatigued due to the decreased oxygen delivery to their organs and tissues. NCSBN Client Need: Topic: Physiological Integrity, Subtopic: Physiological adaptation; Hematology Last Updated - 15, Oct 2021

The nurse is caring for a terminally ill 8-year-old boy with leukemia. The health care provider expects he will only live for another 2-3 months. The nurse should know which of the following when explaining to him about the concept of death and illness? Select all that apply. A. School-age children do not understand their own mortality. B. School-age children feel very vulnerable when dealing with an illness. C. Each child is unique in how they process their diagnosis. D. The child will express their desire to tie up loose ends. Submit Answer

Explanation Choices A, B, and C are correct. Choice A is correct. Children understand the four main concepts (Irreversibility, finality, inevitability, and causality) of death differently at each age group. Understanding how children perceive death at different stages helps the nurse adequately support the child in coping with the illness. School-age children from 6 to 9 years of age do not understand the concept of mortality well. They start developing some understanding regarding the permanence/irreversibility of death but see it as something that only applies to older adults. Therefore, discussions around their "own" death will be confusing for them since they do not think abstractly; these children also do not understand the causality of death. At the age of 10 to 12 years, most children fully understand permanence (death is permanent), inevitability (death is universal for all living beings including themselves), causality (the causes of death), and finality of death (all functioning stops with death). Choice B is correct. School-age children feel very vulnerable when dealing with an illness. They are curious about the physical and biological aspects of death. They have fears that death will hurt and about what they may experience after death, and worry about what will happen to their body. Choice C is correct. Each child is unique in how they process their diagnosis. There is no perfect pattern of how a child handles a terminal diagnosis and no handbook to teach them to cope with grief. The nurse should be aware that each child will be unique and require support differently. Choice D is incorrect. It is unlikely that a school-age child will express a desire to tie up loose ends in processing their terminal diagnosis. Because of a lack of abstract thinking, they do not often have "loose ends" to tie up. This would be more characteristic of an adolescent/adult processing their terminal diagnosis. NCSBN Client Need: Topic: Psychosocial Integrity; Subtopic: Pediatric oncology

You are reinforcing the education provided to your 8-year-old patient diagnosed with sickle cell anemia. He had three sickle crises events this year. Which of the following points do you enforce with him and his parents to help prevent more sickle cell crises? Select all that apply. A. Drink lots of water B. Perform vigorous exercise for 60 minutes a day C. Take proper precautions if flying on airplanes D. Call the PCP if he becomes febrile Submit Answer

Explanation Choices A, C, and D are correct. A is correct. Hydration is an essential component of preventing a sickle cell crisis, so this is a critical education. By drinking lots of water, the boy will increase the volume in his vascular space with fluid, substantially "thinning out" the sickled cells. In other words, they will not be as concentrated anymore. This will help to prevent the sickled cavities from snagging on vessels, creating occlusions, and causing a crisis. C is correct. If patients with sickle cell disease fly on airplanes, they need to take proper precautions. In planes, you are at a very high altitude where there is much less oxygen. This can be a trigger for a sickle cell crisis because it leads to a high oxygen demand state. Precautions to take if they do so include staying very well hydrated, and possibly having an oxygen mask available. Patients with many crisis events may need to avoid flying on airplanes. D is correct. The parents need to know to call the child's primary care doctor if he is ill with a fever. Since the body demands more oxygen when it is febrile, temperatures are a trigger for sickle cell crises and must be treated promptly. Choice B is incorrect. While promoting a healthy lifestyle is always essential, vigorous exercise is a specific trigger for a sickle cell crisis. During strenuous exercise, the tissues have a high oxygen demand and the sickled cells are unable to deliver a sufficient amount of O2, which results in a crisis. So for this patient, 60 minutes of vigorous exercise every day would not be a good recommendation. NCSBN Client Need:Topic: Physiological Integrity, Subtopic: Risk of the potential reduction; Hematology Last Updated - 02, Apr 2022

Which of the following educational points are correct when teaching a patient about iron supplementation? Select all that apply. A. Take the iron supplement 30 minutes after a meal. B. Drink a glass of orange juice with your iron supplement. C. Report any black stools to your doctor. D. Drink the iron suspension with a straw. Submit Answer

Explanation Choices B and D are correct. Orange juice is high in vitamin C, which will help increase the absorption of iron. Also, this will make taking the supplement easier on the stomach and many say it helps with the bad taste (Choice B). If the healthcare provider orders an oral suspension iron supplementation, you should teach your patient to drink it through a straw to avoid staining their teeth. Alternatively, if you are administering the medication to a young child who cannot drink through a straw, you can pull it up in a syringe and squirt it into the back of their mouth behind their teeth (Choice D). Choice A is incorrect. Taking an iron supplement on a full stomach will not allow for proper absorption. You must educate the patient to take their iron supplement on an empty stomach. Choice C is incorrect. Black stools are an expected side effect of iron supplementation. Patients do not need to report black stools to their doctor if they are taking an iron supplement. The nurse should warn them to expect this side effect so that they are not alarmed. NCSBN Client Need: Topic: Physiological Integrity, Subtopic: Pharmacological therapies; Hematology Last Updated - 12, Nov 2021

You are beginning your shift in the Pediatric Intensive Care Unit and are reviewing your patient's labs. The client's primary diagnosis is leukemia, and he has been hospitalized for a secondary infection. He is on broad-spectrum antibiotics. Upon reviewing his labs (see the exhibit), what should be your priority nursing actions? Select all that apply. View Exhibit A. Notify the provider immediately. B. Ensure the patient has a private room. C. Request orders for 1 unit PRBCs to be transfused. D. Restrict visitors and enforce hand hygiene with all guests. Submit Answer

Explanation Choices B and D are correct. The exhibit provided shows moderate absolute neutropenia with an absolute neutrophil count (ANC) of 800/ul. An ANC greater than 1500/ul is considered normal. In immunocompromised patients, neutropenic precautions are indicated when ANC is less than 1000/ul. Neutropenia is an expected finding in a client with leukemia, but the nurse must ensure proper precautions are in place when ANC is lower than 1000/ul. Clients with leukemia are immunocompromised and neutropenia increases their risk of infection further. The nurse must ensure the patient has a private room and restrict visitors. Hand hygiene is essential for all personnel entering the patient's room to prevent infection. Choice C is incorrect. The hemoglobin and hematocrit are normal; therefore, the patient does not need a blood transfusion. Choice A is incorrect. The nurse does not need to notify the provider, these are expected lab values for a patient with leukemia and she should continue her care while ensuring neutropenic precautions are properly in place. The client has a secondary infection and is already on antibiotics. Last Updated - 11, Feb 2022

The nurse is assessing a child with lead poisoning. The nurse should expect which findings? Select all that apply. A. Cardiomegaly B. Headaches C. Irritability D. Abdominal pain E. Peripheral neuropathy Submit Answer

Explanation Choices B, C, D, and E are correct. All of these answer choices are possible symptoms related to lead poisoning. Even small amounts of lead can cause serious health problems Signs and symptoms associated with lead poisoning include learning problems, brain damage, peripheral neuropathy, hyperactivity, headache, and hearing loss. Other symptoms and signs can consist of slow growth, irritability, fatigue, baby colic, memory loss, constipation, vomiting, or nausea. Choice A is incorrect. Lead is a heavy metal, a neurotoxin, and is not cardiotoxic. Additional Info Children younger than six years are especially vulnerable to lead poisoning, which can severely affect mental and physical development. This is because the blood-brain barrier has not been fully developed. Lead is a neurotoxin and may cause hearing loss, peripheral neuropathy, acute encephalopathy, and cognitive dysfunction at high levels. At very high levels, lead poisoning can be fatal. Last Updated - 23, Jun 2022

You are caring for a 14-month-old diagnosed with severe iron deficiency anemia. She is admitted for a blood transfusion and is started on oral iron supplementation. When you change her diaper, you note a dark black stool. What are the appropriate nursing actions? Select all that apply. A. Notify the healthcare provider B. Document the finding C. Continue with your assessment D. Administer the oral iron supplement as prescribed Submit Answer

Explanation Choices B, C, and D are correct. B is correct. Black stools are an expected response to iron supplementation. It is an appropriate nursing action to document this finding in the chart, but no further action is needed. C is correct. Black stools are an expected response to iron supplementation. It is an appropriate nursing action to simply continue with your assessment. Since the finding is expected, no other steps are necessary. D is correct. Black stools are an expected response to iron supplementation. It is an appropriate nursing action to administer the oral iron supplement as prescribed. Choice A is incorrect. Black stools are an expected response to iron supplementation. The nurse doesn't need to notify the healthcare provider of this. NCSBN Client Need: Topic: Physiological Integrity, Subtopic: Pharmacological therapies; Pediatrics - Hematology Last Updated - 08, Nov 2022

The nurse knows that her patient with acute myeloid leukemia (AML) is neutropenic. When reviewing their CBC results in the morning, which of the following does she expect? Select all that apply. A. Increased erythrocyte count B. Decreased neutrophil count C. Increased blast percentage D. Decreased platelet count Submit Answer

Explanation Choices B, C, and D are correct. B is correct. The patient with AML will show a decreased neutrophil count. The question tells you that the patient is neutropenic, meaning that they have a lower than an average number of neutrophils. Due to the proliferation of blast cells, healthy, mature neutrophils are decreased. This leads to a reduced ability for the body to fight infection. C is correct. The patient with AML will have an increased percentage of blast cells. Blast cells are immature neutrophils. There is a proliferation of these immature neutrophils, or blasts, in the bone marrow in patients with AML. This is what causes other healthy cells to die and leads to many signs and symptoms. D is correct. The patient with AML will have a decreased platelet count. This is because of the proliferation of blast cells and suppression of other standard and healthy cells in her bone marrow. The decrease in platelets often can lead to longer clotting times, increased bleeding, and increased bruising in AML. Choice A is incorrect. The patient with AML will likely experience a decrease in erythrocytes or red blood cells. This is because of the proliferation of blast cells and suppression of other standard and healthy cells in her bone marrow. The decrease in erythrocytes often leads to anemia as part of the AML. Last Updated - 06, Jul 2021

While working on a pediatric floor, your 2-year old patient begins experiencing epistaxis. Place the appropriate priority nursing actions in the correct sequence: Apply pressure to the nose for at least 10 minutes Keep the child calm and quiet Help the child to sit up and lean forward If still bleeding, Insert cotton into each nostril Apply ice to the bridge of the nose Submit Answer

Explanation The priority nursing action to take is to keep the child calm and quiet. If the child becomes distressed and is crying, it will exacerbate the bleed. Next, the nurse needs to sit the child up and lean them forward. Many parents think they should pinch the child's nose and tilt their head backward, but this will not aid in stopping the bleed and can be an aspiration risk. Do not let the parent tilt the child's head back. Next, begin applying pressure to the nose, and check to see if the bleeding continues after 10 minutes. If the nose is still bleeding, the next action would be to insert absorbent cotton into each nostril. If the nose continues to bleed after that, the following priority action is to apply ice to the bridge of the nose to aid in vasoconstriction thus stopping the bleed. NCSBN Client Need Topic: Reduction of Potential Risk Subtopic: Potential for Alterations in Body Systems Last Updated - 13, Nov 2019