Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder - ML4
Correct response: elevate head of bed 90 degrees Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, BRAIN TUMORS, p. 1729.
A child is sent to pediatric intensive care following surgery for a brain tumor. Which prescription would the nurse question? phenytoin docusate sodium elevate head of bed 90 degrees position on nonsurgical side
The preschooler is considered immune suppressed 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.
A preschooler who received chemotherapy in the pediatric oncology outpatient department 1 week ago now has a temperature of 101.5°F (38.6°C). Which is the most appropriate response by the nurse? Instruct the parent to immediately obtain and give the antibiotic that the oncologist will order. Ask whether any family members or other close associates are ill. Tell 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.
Correct response: No routine live vaccines are administered while on chemotherapy. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, TEACHING GUIDELINES 46.2, p. 1703.
The pediatric nurse is explaining to a new graduate nurse the differences in planning well-child maintenance for a child with cancer. Which statement by the new nurse demonstrates understanding of the teaching? No routine live vaccines are administered while on chemotherapy. Siblings and parents should not receive nonlive vaccines. Eliminate second-hand smoke within the home. Growth may be stunted due to chemotherapy.
Correct response: Reed-Sternberg cells Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, Hodgkin Disease, p. 1727.
A child is undergoing a series of diagnostic tests for a suspected malignancy. Which diagnostic test result is only present in Hodgkin disease? elevated lymphocytes Reed-Sternberg cells megakaryocyte cells T-lymphocyte surface markers
Explanation: Dehydration increases sickling of cells, so maintaining fluid balance is important.
A school-aged child is admitted to the hospital with a vaso-occlusive sickle cell crisis. Which measure in the child's care plan should be given priority? Maintaining fluids through an intravenous line Seeing that the child ingests a protein-rich diet Beginning active range-of-motion exercises Encouraging the child to take deep breaths hourly
Antiemetics are most effective when given before chemotherapy begins and then on a regular schedule to prevent nausea and vomiting throughout administration of chemotherapy. Nonpharmacologic measures can be used in conjunction with antiemetics but not in place of them
Antiemetics are ordered to control nausea and vomiting in the child undergoing chemotherapy. How can the nurse most effectively use these medications? Start the antiemetic on a scheduled basis when the chemotherapy begins to cause nausea Use the antiemetic after it is clear that nonpharmacologic methods are not effective Provide the antiemetic as needed (PRN) when nausea and vomiting are reported Administer the antiemetic before starting chemotherapy
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 caregivers' anxiety, and increasing the caregivers' knowledge about the causes of crisis episodes, but these goals are not the highest priority.
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 fluid intake will improve. the child's skin integrity will be maintained.
Correct response: Having the child sleep in a single bed and room Encouraging frequent, thorough handwashing Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, Chemotherapy, p. 1685.
The nurse identifies that the client is at risk for an infection related to chemotherapy-induced immunosuppression. What would the nurse include in the teaching plan for the child and parents about reducing the child's risk? Select all that apply. Cheering up the environment with fresh flowers and plants Encouraging frequent close contact with numerous visitors Having the child sleep in a single bed and room Encouraging frequent, thorough handwashing Providing a low-carbohydrate, low-protein diet
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.
Which site is most frequently used to perform a bone marrow aspiration? Femur Iliac crest Humerus Rib cage
Correct response: Factor VIII Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, CLOTTING DISORDERS, p. 1718.
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 V Factor XIII Factor VIII Factor X
Correct response: bruising anorexia sore throat lymphadenopathy Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, LEUKEMIA, p. 1725.
The nurse is providing care to a child with leukemia. When assessing the child, which signs and symptoms would the nurse likely find? Select all that apply. increased hemoglobin lymphadenopathy bruising increased platelet count sore throat anorexia
Correct response: uncontrolled bleeding Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, Disseminated Intravascular Coagulation, p. 1721. uncontrolled bleeding Also, increased D-dimer, prolonged PT and PTT, platelet count 20,000
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? increased antithrombin III levels platelet count 10,000/mm3 (10 ×109/L) decreased D-dimer assay uncontrolled bleeding
Correct response: Administering the measles, mumps, rubella (MMR) vaccine Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, Nursing Analyses, p. 1694.
The toddler with 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" Teaching the importance of taking water safety measures Plotting height and weight on a growth chart Administering the measles, mumps, rubella (MMR) vaccine
Correct response: Mediastinal mass Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, Hodgkin Disease, p. 1728. Difficulty breathing or respiratory distress may indicate a mediastinal mass (which may be seen on a radiograph). Presence of a white reflection in the pupil of the eye may indicate retinoblastoma. Enlarged or tender axillary lymph nodes may indicate lymphadenopathy. Hepatomegaly or splenomegaly may be caused by an infection or tumor in the liver or abdomen
A 14-year-old adolescent with Hodgkin disease is experiencing difficulty breathing and is sent for a radiograph. Which finding should the nurse expect to see on the x-ray report? Lymphadenopathy Mediastinal mass Retinoblastoma Tumor in the liver
Correct response: 8 mcg/dl Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, ANEMIA, p. 1709. Explanation: A blood lead level less than 10 mcg/dL requires no action. A level of 14 mcg/dL would need to be confirmed with a repeat test in 1 month along with parental education for decreased lead exposure and then a repeat test in 3 months. Levels of 20 mcg/dL and 26 mcg/dL need to be confirmed with a repeat test in 1 week along with parental education and a referral to the local health department for investigation of the home for lead reduction.
A nurse is reviewing the medical records of several children who have undergone lead screening. The nurse would identify the child with which lead level as requiring no further action? 14 mcg/dl 8 mcg/dl 20 mcg/dl 26 mcg/dl
Correct response: Ensure neutropenic precautions are in place. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, COMMON MEDICAL TREATMENTS 46.1, p. 1696. Explanation: With stem cell transplants, children are at greatest risk for infection and sepsis. The nurse should ensure neutropenic precautions are used to reduce the change of infection. Monitoring laboratory values, reminding the parent to contact the school, and encouraging therapeutic play are important, but preventing infection in the immunocompromised child is a priority.
The nurse is caring for a child who had a stem cell transplant and is being monitored for engraftment. Which nursing action is priority? Ensure neutropenic precautions are in place. Encourage therapeutic play activities. Remind parents to contact the child's school. Monitor daily complete blood count (CBC).
Correct response: notify a health care provider if the child develops an upper respiratory infection. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, COMMON MEDICAL TREATMENTS 46.1, p. 1696.
To prevent further sickle cell crisis, the nurse would advise the parents of a child with sickle cell anemia to: notify a health care provider if the child develops an upper respiratory infection. encourage the child to participate in school activities, such as long-distance running. administer an iron supplement daily. prevent the child from drinking an excess amount of fluids per day.
Correct response: Bladder Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, COMPARISON CHART 46.1 Childhood Cancer Versus Adult Cancer, p. 1684. Explanation: The most common sites for childhood cancer include the blood, lymph, brain, bone, kidney, and muscle. Bladder is a common site for adult cancer.
A group of nursing students are studying information about childhood cancers in preparation for a class examination. They are reviewing how childhood cancers differ from adult cancers. The group demonstrates understanding of the information when they identify what location as an unlikely site for childhood cancer? Blood Bladder Kidney Brain
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 the future for their son.
A high school football player has been diagnosed as having osteosarcoma of the femur. The parents are angry because they told their son not to play football. Which health teaching points would the nurse include in the teaching plan for the adolescent and his parents? Football injuries do not contribute to the development of a tumor. Osteosarcoma often follows trauma, such as a football injury. You can expect some discoloration of the leg following chemotherapy. Tumor growth is related to your dislike of milk.
Correct response: Iliac crest Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, COMMON LABORATORY AND DIAGNOSTIC TESTS 46.1, p. 1690. 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 nurse is preparing a 7-year-old girl for bone marrow aspiration. Which site should she prepare? Femur Iliac crest Humerus Rib cage
Correct response: "These values will help us monitor the disease." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, ANEMIA, p. 1710 This response answers the parent's questions. In the non severe 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.
The nurse is caring for a child with aplastic anemia. The nurse is reviewing the child's blood work and notes the granulocyte count is about 500, platelet count is over 20,000, and the reticulocyte count is over 1%. The parents ask if these values have any significance. Which response by the nurse is appropriate? "These values will help us monitor the disease." "I'm really not allowed to discuss these findings with you." "The doctor will discuss these findings with you when he comes to the hospital." "These labs are just common labs for children with this disease."
Correct response: temperature of 101°F (38.3°C) or greater Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, Acute Myelogenous Leukemia, p. 1727.
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 temperature of 101°F (38.3°C) or greater blisters, ulcers, or a rash appear difficulty or pain when swallowing
Correct response: Placing a "no abdominal palpation" sign above the child's bed Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, WILMS TUMOR, pp. 1734-1735.
A nurse is providing care to a toddler with nephroblastoma and is being evaluated. Which nursing action would be most important? Preventing weight-bearing activities Preparing the child for chemotherapy Restricting the child's visitors Ensuring that the child be allowed nothing by mouth Placing a "no abdominal palpation" sign above the child's bed
Explanation: Idiopathic thrombocytopenic purpura is the result of a decrease in the number of circulating platelets in the presence of adequate megakaryocytes, which are precursors to platelets. Because bleeding can occur with this disease process, the diagnosis most appropriate for the client at this time is risk for bleeding related to insufficient platelet formation. Reduced numbers of platelets would not increase the client's risk for infection. Reduced numbers of platelets does not increase the client's risk for renal impairment. Reduced risk of platelets will not lead to an ineffective breathing pattern.
Which nursing diagnosis should the nurse identify as being the most appropriate for a child with idiopathic thrombocytopenic purpura? Risk for infection related to abnormal immune system Risk for bleeding related to insufficient platelet formation Ineffective breathing pattern related to decreased white blood count Risk for altered urinary elimination related to kidney impairment
Correct response: "We'll need to have a match to a donor." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, Hematopoietic Stem Cell Transplantation, p. 1685.
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? "The risk for rejection is much less with this type of transplant." "You'll need to have an incision in your hip area to instill the cells." "We'll need to have a match to a donor." "You won't need to receive the high doses of chemotherapy before the transplant."
Correct response: has a low platelet count. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, CLOTTING DISORDERS, p. 1723. Children with leukemia develop lesions of the gastrointestinal tract. If touched by a thermometer, these bleed easily; blood coagulation is poor because of a decreased platelet count
A 4-year-old child has developed acute lymphoblastic leukemia (ALL). Nursing care for the child with ALL involves taking axillary, rather than rectal, temperatures because the child: is prone to diarrhea. is anemic. has a low white blood cell count. has a low platelet count.
Correct response: The child has mild to moderate iron deficiency. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, Iron-Deficiency Anemia, p. 1707. Explanation: The recommended dosage for iron supplementation for a child with mild to moderate iron deficiency is 3 mg/kg/day of ferrous fumarate. A prophylactic dose is 1 to 2 mg/kg/day of up to a maximum of 15 mg elemental iron per day. Severe iron deficiency requires 4 to 6 mg/kg/day of elemental iron in three divided doses. Transfusion of packed red blood cells is reserved for the most severe cases. Prior to the transfusion of packed red blood cells, the nurse would follow specific blood bank guidelines.
A 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 requires a prophylactic dose of iron. The child has mild to moderate iron deficiency. The child is being prepared for packed red blood cell administration. The child has severe iron deficiency.
Correct response: Administer broad-spectrum antibiotics intravenously. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, TABLE 46.3 Oncologic Emergencies, p. 1706. 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.
A client with cancer is diagnosed with typhlitis. Which emergency intervention would the nurse perform? Administer diuretics. Administer broad-spectrum antibiotics intravenously. Monitor serum sodium levels. Maintain fluid restriction to below maintenance levels.
Correct response: "Preterm infants are at risk for iron-deficiency anemia." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, Iron-Deficiency Anemia, p. 1707. 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.
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." "Preterm infants are at risk for iron-deficiency anemia." "Your infant may have been having excessive diarrhea." "Infants with pyloric stenosis require ferrous sulfate."
Correct response: disseminated intravascular coagulation Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, Disseminated Intravascular Coagulation, p. 1721. Explanation: Disseminated intravascular coagulation (DIC) is an acquired coagulopathy that, paradoxically, is characterized by both thrombosis and hemorrhage. The outcome for this patient is: The child will maintain adequate tissue perfusion of all body systems affected by DIC and regain adequate laboratory values for hemostasis.
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? hemophilia disseminated intravascular coagulation iron-deficiency anemia von Willebrand disease
Correct response: "Red meat is a good option; he loves the hamburgers from the drive-thru." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, Iron-Deficiency Anemia, p. 1708. While iron from red meat is the easiest for the body to absorb, the nurse must limit fast food consumption from the drive-thru as it is also high in fat, fillers, and sodium
A nurse is providing dietary interventions for a 5-year-old with an iron deficiency. Which response indicates a need for further teaching? "There are many iron fortified cereals that he likes." "Red meat is a good option; he loves the hamburgers from the drive-thru." "I must encourage a variety of iron-rich foods that he likes." "He will enjoy tuna casserole and eggs."
Correct response: headache, vision changes, and vomiting Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, BRAIN TUMORS, p. 1729. 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 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 projectile vomiting, lethargy, and coma headache, epistaxis, and dizziness headache, vision changes, and vomiting
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 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? Observation reveals nystagmus and head tilt. Examination shows temperature of 101.4° F (38.6°C) and headache. Observation reveals a cough and labored breathing. Vital signs show blood pressure measures 120/80 mm Hg.
Correct response: "The MRI uses radio waves and magnets to produce a computerized image of the body." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, COMMON LABORATORY AND DIAGNOSTIC TESTS 46.1 (Continued), p. 1691. Explanation: The MRI uses radio waves and magnets to produce a computerized image of the body. The bone scan is a nuclear scanning test to rule out cancer involving the bones or determine extent of bone involvement. The ultrasound uses sound waves to create images that visualize body structures and locate masses. Radiography uses radiation to examine soft tissue and bony structures of the body.
The nurse is caring for a 14-year-old client scheduled for magnetic resonance imaging (MRI). The nurse explains the test to the child and family. Which information would be most appropriate to include in the explanation? "The MRI uses sound waves to create images that visualize body structures and locate masses." "The MRI is a nuclear scanning test to rule out cancer involving the bones or determine extent of bone involvement." "The MRI uses radio waves and magnets to produce a computerized image of the body." "The MRI uses radiation to examine soft tissue and bony structures of the body."
Correct response: tachycardia and respiratory distress Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, TABLE 46.3 Oncologic Emergencies, p. 1706. Increased heart rate, murmur, and respiratory distress are symptoms of hyperleukocytosis (high white blood cell count) which is associated with leukemia. Increased heart rate and blood pressure are indicative of tumor lysis syndrome, which may occur with acute lymphoblastic leukemia, lymphoma, and neuroblastoma. Wheezing and diminished breath sounds are signs of superior vena cava syndrome related to non-Hodgkin's lymphoma or neuroblastoma. Respiratory distress and poor perfusion are symptoms of massive hepatomegaly which is caused by a neuroblastoma filling a large portion of the abdominal cavity.
The nurse is caring for a 6-year-old girl with leukemia who is having an oncologic emergency. Which signs and symptoms would indicate hyperleukocytosis? bradycardia and distinct S1 and S2 sounds respiratory distress and poor perfusion tachycardia and respiratory distress wheezing and diminished breath sounds
Correct response: Transfuse 1 unit of packed red blood cells. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, COMMON MEDICAL TREATMENTS 46.1, p. 1696. Explanation: In a situation where the child exhibits signs of anemia related to acute hemorrhage, the nurse should anticipate administering a transfusion of packed red blood cells to improve oxygenation and circulation. Administration of antibiotics, pain assessment, and family education can be performed after the beginning the blood transfusion.
The nurse is caring for a child admitted to the hospital for an open fracture of the femur following a motor vehicle accident. The nurse notes the following lab values: white blood cells 10,000/mm3, hemoglobin 7.9 g/dl (79 g/L), hematocrit 28%, platelets 151,000/mm3. Which nursing action is priority? Transfuse 1 unit of packed red blood cells. Administer antibiotics intravenously stat. Provide the family with preoperative instructions. Ask the child to rate pain on a scale 0 to 10.
Correct response: following guidelines for reverse isolation Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, COMMON MEDICAL TREATMENTS 46.1, p. 1696. 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 protective 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.
The nurse is caring for a child with leukemia. Which nursing intervention would be the highest priority for this child? grouping nursing care providing age-appropriate activities following guidelines for reverse isolation encouraging the child to share feelings
Correct response: "I mix ferrous sulfate with milk in a bottle." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, DRUG GUIDE 46.1 Common Drugs for Hematologic and Neoplastic Disorders, p. 1698. 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 nurse is caring for a toddler taking ferrous sulfate for severe iron-deficiency anemia. Which report by the parent is most concerning? "My child's stools are darker than usual." "I brush my child's teeth once every day." "I mix ferrous sulfate with milk in a bottle." "My child takes ferrous sulfate after meals."
Correct response: One pupil appears white. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, RETINOBLASTOMA, p. 1736.
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's eye appears to be protruding. One pupil appears white. The infant always keeps her eyes tightly closed. The infant tugs and pulls at one ear.
Correct response: macrocytic red blood cells (RBCs) Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, LABORATORY AND DIAGNOSTIC TESTING, p. 1686.
The nurse is evaluating the complete blood count of a 7-year-old child with a suspected hematological disorder. Which finding is associated with an elevated mean corpuscular volume (MCV)? hemoglobin (Hgb) of 11.2 g/dl (112 g/L) decreased white blood cells (WBCs) platelet count of 250,000 macrocytic red blood cells (RBCs)
Explanation: Following a sickle cell crisis, the child should avoid extremely strenuous activities that may cause oxygen depletion. Fluids are encouraged, pain management will be needed, and the child's legs may be elevated to relieve discomfort, so these are all statements that indicate an understanding of caring for the child who has had a sickle cell crisis.
The nurse is preparing a child for discharge following a sickle cell crisis. Which statement by the mother indicates a need for further teaching? "I bought the medication to give to her when she says she is in pain." "She has been down, but playing in soccer camp will cheer her up." "I put her legs up on pillows when her knees start to hurt." "She loves popsicles, so I'll let her have them as a snack or for dessert."
Correct response: Assessing the child's level of consciousness. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, BRAIN TUMORS, p. 1729.
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? Providing a tour of the intensive care unit. Assessing the child's level of consciousness. Having the child talk to another child who has had this surgery. Educating the child and parents about shunts.
Correct response: painless, enlarged lymph node Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, LYMPHOMAS, pp. 1727-1728.
The nurse is reviewing the medical record of a child diagnosed with Hodgkin lymphoma at the asymptomatic stage. Which would the nurse identify as typically the first sign reported by the child? night sweats anorexia weight loss painless, enlarged lymph node
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 African Americans. Either sex can have the trait and disease.
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." "Males are much more likely to have the disease than females." "The trait or the disease is seen in one generation and skips the next generation." "If the trait is inherited from both parents the child will have the disease."
Correct response: Provide nutritious snacks such as a milkshake. Suggest eating prior to chemotherapy. Encourage the child to pick foods that are appetizing. Maintain pleasant family meal times even if child is not hungry. Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, Nursing Analyses, p. 1692.
The nurse is teaching parents about help improving their child's nutritional status while on chemotherapy. What information would be included in the teaching? Select all that apply. Suggest eating prior to chemotherapy. Provide nutritious snacks such as a milkshake. Offer larger portions at meal time to encourage eating. Maintain pleasant family meal times even if child is not hungry. Use honey to improve taste of cereals. Encourage the child to pick foods that are appetizing.
Correct response: cheeseburger, broccoli, and fresh strawberries Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, DRUG GUIDE 46.1 Common Drugs for Hematologic and Neoplastic Disorders, p. 1698. Explanation: Children with iron-deficiency anemia require diets rich in iron and vitamin C (vitamin C enhances iron absorption). Meats are excellent sources of iron. Broccoli is a good source of iron, and strawberries are a good source of vitamin C. To help the body absorb the most iron from the meal, tea and foods rich in calcium (such as milk and cheese) should be avoided.
The nurse will select which meal as the best choice for a child with iron-deficiency anemia? cheeseburger, broccoli, and fresh strawberries chicken breast, French fries, and sweetened tea two slices of pepperoni pizza and a glass of skim milk peanut butter sandwich, cheese stick, and applesauce
Correct response: "ITP is primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason." Explanation: Reference: Ricci, S. S., Kyle, T., & Carman, S., Maternity and Pediatric Nursing, 4th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder, Idiopathic Thrombocytopenia Purpura, p. 1719. 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 parents of a 6-year-old child with idiopathic thrombocytopenic purpura (ITP) ask the nurse conducting an assessment of the child what causes the disease. What is the nurse's best response? "ITP is primarily an autoimmune disease in which the immune system attacks and destroys the body's own platelets, for an unknown reason." "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 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 procoagulant factor."
