Chapter 46 PrepU Cancer

The nurse is obtaining a health history on a child diagnosed with idiopathic thrombocytopenic purpura (ITP). After asking about a viral illness, what question should the nurse ask next to gather more information? "Has your child recently had the measles, mumps, rubella (MMR) vaccine?" "Has your child had any bloody stools?" "When did the bruising begin?" "Has your child experienced any nose bleeds?"

"Has your child recently had the measles, mumps, rubella (MMR) vaccine?"

The nurse is preparing a child for discharge following a sickle cell crisis. Which statement by the mother indicates a need for further teaching? "She loves popsicles, so I'll let her have them as a snack or for dessert." "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 has been down, but playing in soccer camp will cheer her up." Rationale: Following a sickle cell crisis, the child should avoid extremely strenuous activities that may cause oxygen depletion. Fluid are encouraged, pain management will be needed, child's legs may be elevated to relieve discomfort.

After teaching a group of students about hemophilia, the instructor determines that the students have understood the information when they identify hemophilia A as involving a problem with: platelets. factor IX. plasmin. factor VIII.

factor VIII.

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

Handle the child gently when transferring to a stretcher.

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

Calling the doctor if the child gets a sore throat Rationale: Calling the doctor if the child gets a sore throat is the priority. Because of the child's impaired immune system, any sign of potential infection, such as sore throat, must be evaluated by a physician.

The nurse is caring for a 6-year-old boy with non-Hodgkin lymphoma who is being treated with monoclonal antibodies. What recommendation would the nurse include in the child's plan of care? Monitoring for allergic reactions or anaphylaxis. Assessing the child's hydration status secondary to vomiting. Monitoring for complaints of bone pain. Assessing for signs of capillary leak syndrome.

Monitoring for allergic reactions or anaphylaxis. rationale: The nurse would monitor for infusion-related reactions and anaphylaxis if monoclonal antibodies were administered and would have epinephrine, antihistamines, and steroids available at the bedside for treatment if a reaction occurred. Assessing the level of hydration due to vomiting would be necessary if tumor necrosis factor was administered. The flu-like symptoms produced by interferons also require hydration maintenance. Monitoring for complaints of bone pain is appropriate when administering colony-stimulating factors such as filgrastim or sargramostim. Assessing for signs of capillary leak syndrome within 2 to 12 hours of the start of treatment is necessary when interleukins are used.

A 5-year-old client has been diagnosed with leukemia and is currently on chemotherapy and radiation. The child is having difficulty due to mucositis. Which is the most appropriate nursing diagnosis for this child? Pain due to neoplastic process in bone Disturbed body image related to loss of hair after chemotherapy Compromised family coping related to long-term chemotherapy regimen Risk for imbalanced nutrition, less than body requirements, related to inflammation

Risk for imbalanced nutrition, less than body requirements, related to inflammation Rationale: Mucositis is inflammation of the oral mucosa, which puts the child at risk for imbalanced nutrition.

A nurse is providing care to a child with hemophilia who is experiencing muscle and joint involvement related to the bleeding. Which would the nurse include as an adjunctive measure to control bleeding? compression heat exercise lowering extremities

Compression Rationale: RICE

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

Iliac crest

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

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

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

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

Administer broad-spectrum antibiotics intravenously. Rationale: 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.

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

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

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? Osteosarcoma often follows trauma, such as a football injury. You can expect some discoloration of the leg following chemotherapy. Football injuries do not contribute to the development of a tumor. Tumor growth is related to your dislike of milk.

Football injuries do not contribute to the development of a tumor. Rationale: 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. 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.

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

Initiate intravenous access. Rationale: In a situation where the child is experiencing a sickle cell crisis, a priority nursing action is to initiate intravenous access to begin rehydrating the child to halt the sickling process.

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? "Infants with pyloric stenosis require ferrous sulfate." "Preterm infants are at risk for iron-deficiency anemia." "Your infant may have been having excessive diarrhea." "Ferrous sulfate helps improve red blood cell formation."

Preterm infants are at risk for iron-deficiency anemia."

The nurse is examining the hands of a child with suspected iron deficiency anemia. Which finding should the nurse expect? capillary refill in less than 2 seconds pink palms and nail beds absence of bruising spooning of nails

Spooning of nails Rationale : A convex shape of the fingernails termed 'spooning' can occur with iron deficiency anemia.

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

We'll give him the medicine before he eats his meals." "He has to make sure that he brushes his teeth well." "He might get constipated, so we'll try to get him to eat some more fiber." "We'll have him take the liquid medicine with some orange or pineapple juice." Rationale: Ferrous sulfate should be given on an empty stomach with water to enhance absorption

The health care provider has just informed the parents of a 3-year-old that their child has leukemia. The mother begins crying and tells the nurse she does not want her baby to die. What is the nurse's best response? "Don't worry, the health care provider is very good at treating leukemia." "I don't blame you for being upset; any parent would be scared too." "I know this is scary, but leukemia has a high cure rate in children these days." "You are very lucky to have caught it so early; that makes the treatments easier."

"I know this is scary, but leukemia has a high cure rate in children these days."

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

"My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C."

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

ALL Rationale:

The nurse is caring for a pediatric client who is scheduled for the surgical removal of a Wilms tumor. Which action is contraindicated in the client's care? Intravenous fluids Abdominal palpation Foley catheter placement Supine positioning

Abdominal palpation

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

Administering oxygen Administering analgesics Maintaining fluid intake Rationale: A vaso-occlusive crisis occurs when sickle-shaped cells are clumped together in a joint or organ. This causes severe pain and hypoxia to the tissues. The management for a vaso-occlusive crisis is to provide adequate pain relief, oxygen to correct the hypoxemia, and increased IV fluids to thin out viscosity and allow the cells to flow in the vascular system.

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? Bladder Blood Brain Kidney

Bladder

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

Bone marrow aspiration

The child is prescribed liquid ferrous sulfate. The nurse should encourage the child to take which action immediately after each dose to best eliminate possible side effects? Drink a glass of milk Brush his or her teeth Remain in an upright position for at least 15 minutes Not eat or drink for one hour

Brush his or her teeth

A teenage girl asks why chemotherapy causes hair loss. Which response by the nurse is accurate? Circulation to the head causes large doses of chemotherapy to reach the scalp. Hair is not a living tissue, and it is easily damaged by chemotherapy. Chemotherapy affects cancer cells and normal cells that multiply rapidly. Hair is exposed to the sun, which increases sensitivity to chemotherapy.

Chemotherapy affects cancer cells and normal cells that multiply rapidly.

Which diagnosis would be most appropriate for an infant with a large retinoblastoma after surgery? Anticipatory grieving related to change in body image Fear related to loss of normal vision Pain related to retinal removal Disturbed sensory perception related to enucleation

Disturbed sensory perception related to enucleation

The pediatric nurse reviews the radiographs of a child and observes that there are lesions on the bone. The nurse interprets this finding as suggesting which condition? Ewing sarcoma Hodgkin disease non-Hodgkin lymphoma neuroblastoma

Ewing sarcoma

A 15-year-old client diagnosed with von Willebrand disease has reached menarche. Based on this fact, what information is most important for the nurse to convey to the client? Bruising may occur in the perineal area. Expect menstrual bleeding to be heavy. Occasional skipped periods can be expected. The duration of each period will be short.

Expect menstrual bleeding to be heavy

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

Monitor the site dressing and vital signs. Rationale: Monitoring vital sx and dressing for sx of bleeding is a priority after bone marrow aspiration.

The nurse is assessing a child and notices pinpoint hemorrhages appearing on several different areas of the body. The hemorrhages do not blanch on pressure. The nurse documents this finding as: petechiae. purpura. ecchymosis. poikilocytosis.

Petechiae

A nurse is providing care to a toddler with nephroblastoma and is being evaluated. Which nursing action would be most important? Restricting the child's visitors Placing a "no abdominal palpation" sign above the child's bed Ensuring that the child be allowed nothing by mouth Preparing the child for chemotherapy Preventing weight-bearing activities

Placing a "no abdominal palpation" sign above the child's bed

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

Prepare to administer factor replacement medication Rationale: Many clients with hemophilia have repeated episodes of hemarthrosis or bleeding into the joints, and develop functional impairment of the joints, despite careful treatment. To assist in limiting impairment, the nurse would prepare to administer factor replacement medications, such as plasma, recombinant clotting factor VIII, or a clotting promotor medication. The nurse would document the finding, notify the health care provider, and assess the client for additional symptoms after limiting the amount of blood loss.

What is the priority action the nurse should take when caring for a child newly diagnosed with Wilms tumor (nephroblastoma)? Protect the abdomen from manipulation. Assess for constipation. Control acute pain. Obtain a catheterized urine specimen.

Protect the abdomen from manipulation.

When developing the postoperative plan of care for a child with sickle cell anemia who has undergone a splenectomy, which would the nurse identify as the priority? Risk for infection Impaired skin integrity Deficient fluid volume Risk for delayed growth and development

Risk for infection Removal of the spleen places the child at significant risk for infection.

The nurse is assessing a school-aged child with sickle-cell anemia. Which assessment finding is consistent with this child's diagnosis? Slightly yellow sclera Enlarged mandibular growth Increased growth of long bones Depigmented areas on the abdomen

Slightly yellow sclera Rationale: In sickle-cell anemia, eye scleras become icteric or yellowed from the release of bilirubin from destruction of the sickled cells.

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 has severe iron deficiency. The child is being prepared for packed red blood cell administration.

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

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

The child's fluid intake will improve Rationale: 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.

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

following guidelines for reverse isolation Rationale: The child with leukemia is susceptible to infection, especially during chemotherapy. Infections such as meningitis, septicemia, and pneumonia are the most common causes of death. To protect the child from infectious organisms, follow standard guidelines for reverse isolation.

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

lumbar puncture Rationale: Lumbar punctures are performed to determine if leukemic cells have infiltrated the central nervous system.

The nurse develops a meal plan for a child with iron-deficiency anemia. Which meal would the nurse teach the parent has the highest amount of iron? red meat, eggs, oatmeal, and dried fruit chicken, corn, brown rice, and oranges pork, broccoli, white rice, and strawberries tuna salad with eggs, whole wheat crackers, and blueberries

red meat, eggs, oatmeal, and dried fruit Rationale: Foods that have the highest resources of iron include red meat, tuna, eggs, tofu, Enriches grains, dried beans and peas, dried fruits, green leafy vegetables, and iron-fortified breakfast cereals. All fruits listed have iron, when dried them, iron level increased.

The nurse is administering meperidine as ordered for pain management for a 10-year-old boy in sickle cell crisis. The nurse would be alert for: seizures. behavioral addiction. priapism. leg ulcers.

seizures.

A couple is expecting a child. The fetus undergoes genetic testing and the couple discover the fetus has sickle cell disease. The couple ask the nurse how most commonly happens. Which statement is accurate for the nurse to provide? "Sickle cell disease occurs from a random genetic mutation." "Sickle cell disease is passed to a fetus when both parents have the gene." "Sickle cell disease is passed to a fetus when one of the parents has the gene." "Sickle cell disease can be passed to the fetus in many ways. We will know more at birth."

"Sickle cell disease is passed to a fetus when both parents have the gene." Rationale: sickle cell disease is an inherited disease, the recessive gene is passed from both parents who either have the disease or the trait.

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

Antiemetic Radiation sickness that includes N&V is most frequently encountered systemic effects. In order to counteract this, a child is prescribed an antiemetic before the procedure.

The nurse is assessing a 10-year-old girl with acute lymphoblastic leukemia. What information would lead the nurse to suspect that the cancer has infiltrated the central nervous system? Child reports facial palsy and vision problems Observing petechiae, purpura, or unusual bruising Noting adventitious breath sounds during auscultation Palpation of abdomen reveals enlarged liver and spleen

Child reports facial palsy and vision problems Rationale Observing petechiae, purpura, or unusual bruising -Result from decrease platelet levels, may present regardless of metastasis Noting adventitious breath sounds during auscultation Palpation of abdomen reveals enlarged liver and spleen- Hepatomegaly and splenomegaly may result from infection, not metastasis

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? Tell the parent to administer acetaminophen every 4 hours until the fever dissipates. Ask whether any family members or other close associates are ill. Have the parent bring the child to the pediatric oncology clinic as soon as possible. Instruct the parent to immediately obtain and give the antibiotic that the oncologist will order.

Have the parent bring the child to the pediatric oncology clinic as soon as possible. Rationale: The preschooler is considered immunosuppressed following recent chemotherapy. A fever can mean sepsis, which would require immediate investigation of blood and other body fluids to identify the organism, plus prompt treatment with an IV antibiotic.

A 3-year-old child is hospitalized with a diagnosis of sickle cell anemia and is experiencing a pain crisis. Using the FACES scale, the nurse assesses the child's pain to be a 10 on a scale of 1 to 10. The child is receiving intravenous fluids and oxygen at 2 L/min via nasal cannula. The parent is at the bedside holding the child's hand and has a concerned look. What is the nurse's priority in caring for the child? Ask the parent if he or she has questions about the plan of care. Provide diversional activities for the child. Implement strategies to address the child's pain. Contact the health care provider to meet with the parent.

Implement strategies to address the child's pain. Rationale: In the case, the nurse's priority is to address the child's pain. The child is already receiving IV fluids and O2. That, in combination with analgesia, will assist in resolving the crisis.

The nurse assesses a child and notes the following: oral temperature 102.1°F (39°C), plethora, and new onset difficulty speaking. Which health care provider prescription will the nurse request? Select all that apply. Initiate intravenous (IV) normal saline. Obtain computed tomography (CT) scan. Administer acetaminophen every 4 hours. Give dose of erythropoietin subcutaneously. Call laboratory for complete blood count (CBC).

Initiate intravenous (IV) normal saline. Obtain computed tomography (CT) scan. Administer acetaminophen every 4 hours. Call laboratory for complete blood count (CBC).

A 15-year-old boy has been diagnosed with an osteosarcoma of the distal femur. He also demonstrates a chronic cough, dyspnea, and chest pain, along with chronic leg pain. Based on these findings, the nurse should suspect metastasis to which body area? Lungs Heart Brain Rib cage

Lung

A nurse is providing dietary interventions for a 5-year-old with an iron deficiency. Which response indicates a need for further teaching? "Red meat is a good option; he loves the hamburgers from the drive-thru." "He will enjoy tuna casserole and eggs." "There are many iron fortified cereals that he likes." "I must encourage a variety of iron-rich foods that he likes."

Red meat is a good option; he loves the hamburgers from the drive-thru."

The nurse is caring for a school-age child recovering from an allogeneic stem cell transplant. What nursing action best ensures the child does not develop an infection after the transplant? Select all that apply. Restrict all visits from other children. Provide sterilized age-appropriate play materials. Send for total body irradiation immediately after the transplant. Arrange time for studying while in the hospital. Encourage eating raw vegetables for each meal after the procedure.

Restrict all visits from other children. Provide sterilized age-appropriate play materials. Rationale: Send for total body irradiation immediately Before the transplant.

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 wheezing and diminished breath sounds respiratory distress and poor perfusion tachycardia and respiratory distress

tachycardia and respiratory distress rationale: Increased heart rate, murmur, and respiratory distress are symptoms of hyperleukocytosis (high white blood cell count) which is associated with leukemia.

In discussing the causes of iron-deficiency anemia in children with a group of nurses, the following statements are made. Which of these statements is a misconception related to iron-deficiency anemia? "A family's economic problems are often a cause of malnutrition." "Milk is a perfect food, and babies should be able to have all the milk they want." "Caregivers sometimes don't understand the importance of iron and proper nutrition." "Children have a hard time getting enough iron from food during their first few years."

"Milk is a perfect food, and babies should be able to have all the milk they want."

A nurse is preparing a teaching plan for a child with hemophilia and his parents. Which information would the nurse be least likely to include to manage a bleeding episode? Apply heat to the site of bleeding. Apply direct pressure to the area. Elevate the injured area such as a leg or arm. Administer factor VIII replacement.

Apply heat to the site of bleeding. Rationale: Ice or cold compresses, not heat, would be applied to the site of bleeding.

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

Ensure neutropenic precautions are in place. rationale: 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.

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

Facial changes Rationale: Steroid therapy may cause moon face, weight gain/fat pads, increase appetite

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 peanut butter sandwich, cheese stick, and applesauce two slices of pepperoni pizza and a glass of skim milk

cheeseburger, broccoli, and fresh strawberries

The parent of a child with Down syndrome calls the nurse and reports 3 weeks of a lack of energy, limping, and weight loss in the young child. What is the most appropriate response by the nurse? "If symptoms persist, your child needs to be seen within the week." "Bring your child to the primary health care provider to be examined." "Give your child acetaminophen every 4 hours for a day. If no improvement, call back." "Limit active play and offer frequent small snacks and meals."

"Bring your child to the primary health care provider to be examined." Rationale: Symptoms could indicate acute lymphoblastic leukemia (ALL). Compared with other children, children with Down syndrome have 15 times the risk of developing ALL. The nurse would recommend the child come in for further assessment to determine what, if any, treatment is needed for this child.

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 is a serious bleeding disorder characterized by a decreased, absent, or dysfunctional procoagulant factor." "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 primarily an autoimmune disease in which the immune system attacks and destroys the body's own platelets, for an unknown reason." Rationale: 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. The child will exhibit symptoms of excessive petechiae, purpura, and bruising. Hemophilia A and hemophilia B are distinguished by the particular procoagulant factor that is decreased, absent, or dysfunctional. Iron-deficiency anemia occurs when the body's iron stores are depleted. Hereditary spherocytosis (HS) is characterized by loss of surface area on the red blood cell membrane.

The nurse is educating the parents of a school-aged child with acute lymphoblastic leukemia (ALL). What statement by the parents indicates the parents need further education? "My child may have bone pain as the abnormal lymphocytes affect the bone periosteum." "My child will have increased urination because the immature white cells affect the kidneys." "My child will have a low hemoglobin and hematocrit levels because of bone marrow dysfunction." "My child will be given chemotherapy to help restore normal bone marrow function."

"My child will have increased urination because the immature white cells affect the kidneys."

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? Assessing the child's level of consciousness. Providing a tour of the intensive care unit. Educating the child and parents about shunts. Having the child talk to another child who has had this surgery.

Assessing the child's level of consciousness. Rationale: The priority intervention is to monitor for increase in intracranial pressure bc brain tumors may block cerebral fluid flow or cause edema in the brain. A change in the level of consciousness is just one of several subtle changes that can occur indicating a change in intracranial pressure.

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

CBC Rationale: After obtaining the child's history and symptoms, the nurse would prepare the child for laboratory blood studies to assess the child's white blood cell (WBC) count. A complete blood cell (CBC) count will provide data on the child's WBC level. A bone marrow aspiration would be scheduled based on the results of the CBC as it is required to confirm the diagnosis of leukemia.

Parents tell the nurse who is admitting their infant for a well-child exam that they recently saw a "white glow" in their child's left pupil. What is the nurse's best response? "Most parents mention a red color." "I will report this to the pediatrician." "Has your baby been rubbing either eye?" "A plugged tear duct would not be unusual."

I will report this to the pediatrician Rationale: The white glow may indicate retinoblastoma, immediate investigation is needed.

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

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

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

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

The nurse caring for a 14-year-old scheduled for magnetic resonance imaging (MRI) explains to a family how the test works. Which response accurately describes this test? "The MRI uses radio waves and magnets to produce a computerized image of the body." "The MRI is a nuclear scanning test to rule out cancer involving the bones or determine extent of bone involvement." "The MRI uses sound waves to create images that visualize body structures and locate masses." "The MRI uses radiation to examine soft tissue and bony structures of the body."

The MRI uses radio waves and magnets to produce a computerized image of the body." Rationale: Bone scan is a nuclear scanning test to rule out cancer involving the bones or determine extent of bone involvement. 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 9-year-old boy undergoing chemotherapy whose complete blood count (CBC) with differential reports 7% banded and 13% segmented neutrophils with a white blood cell count of 2,540. He has an oral temperature of 38.6°C (101.5°F). Which intervention would be the priority? administering prescribed broad-spectrum IV antibiotics monitoring his vital signs every 4 hours restricting visitors with symptoms of infection assessing for signs of infection every 8 hours

administering prescribed broad-spectrum IV antibiotics Rationale: His absolute neutrophil count indicates he has neutropenia and his temperature indicates he may have an infection. Monitoring vital signs, restricting visitors with symptoms of infection, and assessing for signs of infection are valid interventions related to neutropenia but are of lesser importance at this point.

A nurse is caring for a child with Hodgkin disease who is in the induction phase of a chemotherapy regimen. The nurse explains to the parents that the goal of this phase is to: destroy any remaining cancer cells. kill enough cancerous cells to induce remission. destroy any residual cancer cells. follow up for recurrent disease or late effects.

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

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. prevent the child from drinking an excess amount of fluids per day. encourage the child to participate in school activities, such as long-distance running. administer an iron supplement daily.

notify a health care provider if the child develops an upper respiratory infection. Infection caused by the streptococcus pneumonia can be lethal to a child with sickle cell, bcz they can cause overwhelming sepsis or meningitis.

A nurse is teaching the parents of a child with sickle cell disease about factors that predispose the child to a sickle cell crisis. The nurse determines that the teaching was successful when the parents identify what as a factor? Fluid overload Infection Respiratory distress Pallor

Infection Rationale: Risk factors of sickle cell crisis: Fever, infection, dehydration, extreme temp, high atitude, excessive physical activity

A nurse is providing teaching to the parents of a child diagnosed with sickle cell anemia. The discussion is focused on precipitating factors for sickle cell crisis. Which statement by the parents requires the nurse to reinforce the teaching? "I make sure my child wears a good warm coat and gloves during winter." "Our family is taking a fun hiking trip up in the mountains next week." "We always take water along when we are on an outing." "I make sure our child is up to date on all immunizations."

"Our family is taking a fun hiking trip up in the mountains next week." Rationale: High altitudes are a contributing factor for sickle cell crisis and should be avoided, as should flights in planes that are not pressurized. Extreme temp, dehydration are trigger.

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

"The tumor is in the muscle."

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

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

A 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 VIII Factor X Factor XIII

Factor VIII

A 5-year-old child is at the pediatric clinic for a well-child visit. Which symptom alerts the health care provider that this child might have acute lymphoblastic leukemia (ALL)? joint pain and swelling anorexia and weight loss abdominal pain, nausea, and vomiting lethargy, bruises, and lymphadenopathy

lethargy, bruises, and lymphadenopathy Rationale: Although all of these symptoms could be related to leukemia, the most likely are lethargy, bruises, and lymphadenopathy. Joint pain and swelling could also be juvenile arthritis or another disorder. Anorexia and weight loss are fairly nonspecific, as is abdominal pain, nausea, and vomiting. With ALL, because the bone marrow overproduces lymphocytes and therefore is unable to continue normal production of other blood components, the first symptoms of ALL in children usually are those associated with decreased RBC production (anemia) such as pallor, low-grade fever, and lethargy. A low thrombocyte (platelet) count will lead to petechiae and bleeding from oral mucous membranes and cause easy bruising on arms and legs. As the spleen and liver begin to enlarge from infiltration of abnormal cells, abdominal pain, vomiting, and anorexia occur. As abnormal lymphocytes invade the bone periosteum, the child experiences bone and joint pain. Central nervous system (CNS) invasion leads to symptoms such as headache or unsteady gait. On physical assessment, painless, generalized swelling of lymph nodes is revealed.

The nurse is explaining the procedure of bone marrow aspiration to a 6-year-old child with leukemia. What explanation would be best to give to the child? "You will need to lie still afterward to prevent a headache." "You may feel pressure on your hip during the procedure." "You will have to lie on your back and hold your breath." "The numbing medicine on your skin will keep you from having pain."

"You may feel pressure on your hip during the procedure." Rationale: Bone marrow aspiration requires hard pressure to allow the needle to puncture the bone. Lidocaine/prilocaine is applied to the skin anywhere from 1-3hrs before to the procedure to help numb the site where the needle will be inserted. The child is placed on the side for the procedure so the health care provider has better access to the iliac crest.

The nurse is providing teaching about iron supplement administration to the parents of a 10-month-old child. It is critical that the nurse emphasize which teaching point to the parents? "You must precisely measure the amount of iron." "Your child may become constipated from the iron." "Please give him plenty of fluids and encourage fiber." "Place the liquid behind the teeth; the pigment can cause staining."

"You must precisely measure the amount of iron." Rationale: The priority is to emphasize to the parents that they precisely measure the amount of iron to be administered in order to avoid overdosing. The other instructions are accurate, but the priority is to emphasize precise measurement.

The toddler with a cancer diagnosis is seen for a well-child checkup. Which health maintenance activity will the nurse exclude? Plotting height and weight on a growth chart Assessing dietary intake by addressing "picky eating" and "food jags" Administering the measles, mumps, rubella (MMR) vaccine Teaching the importance of taking water safety measures

Administering the measles, mumps, rubella (MMR) vaccine Rationale: Live vaccines (viral or bacterial) should not be administered to an immunosuppressed child because of the risk of causing disease

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

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

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 T-lymphocyte surface markers megakaryocyte cells

Reed-Sternberg cells