Chapter19: Hematologic, Immunologic, and Neoplastic Disorders

52. Common side effects of radiation therapy include all of the following except: 1. Endocarditis. 2. Slow bone growth. 3. Alopecia. 4. Abdominal cramping.

1 (1. Pericarditis may occur, but not endocarditis. 2. Growth at the epiphyseal plates slows. 3. Loss of hair is common. 4. Abdominal cramping is common.)

9. What is the most common opportunistic infection in children with the Human Immunodeficiency Virus? 1. Pneumocystic pneumonia 2. CMV 3. Meningitis 4. Encephalitis

1 (1. Pneumocystic pneumonia is most common, and children are treated prophylactically. 2. CMV is not considered an opportunistic infection. 3. Meningitis is not common in children with HIV. 4. Encephalitis can occur, but it is not a cause of infection.)

56. A child with a known neuroblastoma begins vomiting uncontrollably. The nurse assesses the child's _____ for signs of increased intracranial pressure. 1. Pupils and hand grasps 2. Intake and output 3. Respiratory rate 4. Verbal responses

1 (1. Sluggish and dilated pupils along with weakened hand grasps are an indication of increased ICP. 2. Intake and output are not a concern at this time. 3. The child's respiratory rate should be assessed, but it is not the priority at this time. 4. Verbal responses can be assessed, but it is not the priority at this time.)

3. Acquired thrombocytopenia involves antibodies against: 1. Platelets. 2. Basophils. 3. Neutrophils. 4. Eosinophils.

1 (1. Decreased platelet production, increased platelet destruction, or splenic sequestration is common with thrombocytopenia. 2. The basophils are intact with thrombocytopenia. 3. The neutrophils function with thrombocytopenia. 4. The eosinophils are intact with thrombocytopenia.)

11. Evidence of iron deficiency anemia in infants 9 to 12 months of age is most likely to be caused by: 1. Excessive milk intake. 2. Addition of solid foods. 3. Prematurity of the infant. 4. Rh and ABO incompatibility.

1 (1. Excessive milk intake will decrease appetite and result in fewer intakes of foods containing iron. 2. Solid foods will contain iron, thus not causing a deficiency. 3. A premature infant may be anemic for other reasons besides iron deficiency. 4. The incompatibilities would have been noticed earlier in the infant's life. This does not cause iron deficiency.)

7. What factor contributes to a vaso-occlusive crisis in a child with Sickle Cell anemia? 1. Dehydration 2. Alkalosis 3. Infection 4. Stress

1 (1. Fluid replacement with IV fluids increases the flow of blood, which decreases tissue hypoxia and the potential for dactylitis. 2. The child may become alkalotic, but this s not the contributing factor to the vaso-occlusive crisis. 3. Infections can cause dehydration, but this is not the leading cause of the vaso-occlusive crisis. 4. Stress is a manageable condition and does not lead to a vas-occlusive crisis.)

26. A school-age child is admitted with vaso-occlusive Sickle Cell crisis. The child's care should include which of the following? 1. Hydration and pain management 2. Oxygenation and factor VIII replacement 3. Electrolyte replacement and the administration of heparin 4. Correction of alkalosis and reduction of energy expenditure

1 (1. Hydration and pain medication are needed in order for the child to heal. 2. Oxygenation is needed, but factor VIII is not used in Sickle Cell treatment. 3. Hydration is important, but the use of heparin will not decrease the pain. 4. The child needs a balanced electrolyte state and can be as active as possible without pain.)

28. What is the bacteria that most commonly results in respiratory tract infections in patients receiving chemotherapy? 1. Klebsiella 2. E. coli 3. Epstein Barre Virus 4. Proteus

1 (1. Klebsiella is the most common bacteria found in respiratory infections in patients receiving chemotherapy. 2. E. coli is commonly found in GI infections, not respiratory infections. 3. The Epstein Barre Virus is found in neurological tract infections, not respiratory infections. 4. Proteus are not commonly found in patients with respiratory infections that are undergoing chemotherapy.)

10. Which of the following diagnostic tests confirms Hodgkin's disease? 1. Reed-Sternberg cells in the lymph nodes 2. Lymphocytes in the bone marrow 3. Neutrophils in the blood 4. Bacteria in the urine

1 (1. The Reed-Sternberg cells are a diagnostic of Hodgkin's disease. 2. Lymphocytes are naturally found in the bone marrow. 3. Neutrophils are naturally found in the blood to help fight infections. 4. Bacteria in the urine is not a confirmation of Hodgkin's disease.)

18. Which of the following is a reason to do a lumbar puncture on a child with a diagnosis of leukemia? 1. To assess the central nervous system for infiltration 2. To determine increased intracranial pressure 3. To stage the leukemia 4. To rule out meningitis

1 (1. The abnormal cells of leukemia are definitive for the disease. 2. A lumbar puncture can increase ICP, not diagnose it. 3. Staging is done with blood cells, not cerebral spinal fluid. 4. If a child has a known diagnosis of leukemia, the lumbar puncture does not need to be done to identify meningitis unless other blood tests indicate infection.)

55. A father brings his 3-year-old daughter to the cancer treatment center for a follow-up appointment. The previous rounds of chemotherapy were not successful in treating his daughter's cancer. The plan is to provide an allogeneic transplantation. The father verbalizes an understanding of the process when he states: 1. "An allogeneic transplant puts my daughter as the lowest risk for rejection." 2. "I will need to get high doses of chemotherapy for the bone marrow to be appropriate for my daughter's body." 3. "I will need to be in isolation after the donation procedure." 4. "My daughter will need a transplant from her mother and myself to be successful in curing the disease."

1 (1. The allogeneic transplant has the lowest risk of rejection and would be appropriate for the child. 2. The receiver needs the high doses of chemotherapy, not the donor. 3. The daughter will need to be in isolation after the donation to help decrease the risk for infection because the chemotherapy increases her susceptibility to infection. 4. The transplant can come from the mother or the father. The important factor is having an allogeneic match.)

33. A mother has called the triage nurse of the pediatric clinic to ask what she should do for her son's frequent epistaxis episodes. The treatment should include: 1. Having the child sit up with his head tilted forward so that blood does not go down the throat. 2. Encouraging the child to breathe through his nose. 3. Having the child attempt to keep his nose clean. 4. Applying heat to the nares.

1 (1. The blood could be aspirated, so sitting forward will help decrease the occurrence. 2. Breathing through the nose can cause increased pressure and not stop the bleeding. 3. Cleansing and digging in the nose can cause clots to break and cause continued bleeding. 4. Ice should be applied to vasoconstrict the blood vessels to stop the bleeding.)

14. The most frequent presenting signs of leukemia are related to bone marrow infiltration. The main symptoms are: 1. Anemia, infection, and bleeding. 2. Thrombocytopenia, headache, and abdominal pain. 3. Respiratory distress and pain. 4. Confusion and decreased peripheral vascular resistance.

1 (1. The normal bone marrow is replaced with abnormal cells, leading to decreased red blood cells and anemia. The risk of infection relates to the lack of white blood cells and the reduction in platelets of thrombocytopenia. 2. The normal bone marrow is replaced with abnormal cells, leading to decreased red blood cells, which causes ischemia and pain. The risk of infection relates to the lack of white blood cells and the reduction in platelets of thrombocytopenia. Headaches are not a common sign. 3. The normal bone marrow is replaced with abnormal cells, leading to decreased red blood cells, which causes pain. The patient rarely exhibits signs of respiratory distress. 4. Neurological issues and peripheral vascular resistance are rare.)

19. A child with cancer has a platelet count of 4,500/mm3. Which of the following should the nurse prepare to administer? 1. Platelets 2. Packed red blood cells 3. Neupogen 4. Erythropoeitin.

1 (1. The normal level of platelets in greater than 5000/mm3. The child is at a high risk for bleeding, thus platelets are needed to help build clotting factors. 2. PRBC's will not increase clotting time. It will help increase the red blood cell carrying capacity of oxygen. 3. Neupogen stimulates the production of red blood cells. 4. Erythropoietin stimulates bone marrow to produce red blood cells.)

25. Which nursing action is implemented first when a child is admitted to the transplant center for a hematopoietic stem cell transplant? 1. Prepare the child and family for an intensive ablative dose of chemotherapy. 2. Place the child in protective isolation. 3. Maintain a central line catheter. 4. Serve irradiated food and water to the child.

1 (1. The preparation of the child and the caregivers for the weeks of hospitalization and social isolation required is a priority. A discussion with the child and caregivers will include the factors of the critical period of recovery for the client from the removal of cancer cells, transfusing histocompatible stem cells, and monitoring for signs of rejection. 2. Isolation is not the top priority at this time. 3. It is not stated that the child has a central line at this time, thus it is not a priority. 4. The concentration should be on the preparation of what is going to occur and how goals will be met.)

15. A toddler with cancer has a central line catheter for chemotherapy. The priority for the nurse is to: 1. Administer nutrition using the central line. 2. Provide privacy during medication administration. 3. Use the central line to administer antibiotics. 4. Limit visitors to family members.

1 (1. The priority is the prevention of infection during the care of the child as well as making sure that the child has adequate procedures to prevent infection when using the central line. 2. Privacy is important for all patients. 3. The central line can be used for nutrition and medication administration. 4. Additional precautions do not need to be taken for visitors at this time.)

32. Which of the following should the nurse include when teaching the mother of a 9-month-old infant about administering liquid iron preparations? 1. Adequate dosage will turn the stools a tarry green color. 2. Stop immediately if nausea and vomiting occur. 3. Give the medication with meals. 4. Allow the preparation to mix with saliva and bathe the teeth before swallowing.

1 (1. The side effect of oral iron supplements is tarry green stools. 2. Nausea and vomiting are not common side effects of iron supplementation. 3. The medication should be spaced out from the meals to decrease the chance for nausea and vomiting. 4. Most infants do not like the taste of iron supplements and will spit it out if mixed with the saliva.)

47. A father of an 18-month-old boy reports that his son has been constipated, has pain in his abdomen when touched, and seems lethargic since they moved to a new house. The nurse should asses if the environment: 1. Contains lead-based paint. 2. Has pollen in the area surrounding the house. 3. Is near a factory. 4. Is near power lines.

1 (1. The symptoms are common with exposure to lead-based paint, and the nurse should anticipate a blood test. 2. Pollen may cause sneezing as well as watery, itchy eyes, but not the symptoms described. 3. Living near a factory may cause environmental hazards, but the child is showing signs of lead poisoning. 4. The child is showing signs of lead poisoning, which is not found near power lines.)

48. A common opportunistic infection for a child with immune suppression related to HIV is: 1. Tuberculosis. 2. Syphilis. 3. Meningitis. 4. E. Coli.

1 (1. Tuberculosis is one of the most common opportunistic infections in children with HIV. 2. Syphilis is not common in children with HIV. 3. Meningitis is not common in children with HIV. 4. E. Coli may be present in the GI tract, but does not commonly cause further complications for children with HIV.)

58. Identify food sources that are recommended for children to receive iron. Select all that apply. 1. Spinach 2. Broccoli 3. Carrots 4. Chicken breasts 5. Chick peas

1, 2, 4 (1. Green spinach is an iron source. 2. Broccoli is an iron source. 3. Carrots have beta-carotene and fiber, not iron. 4. Chicken breasts do not contain iron, but are a good source of protein. 5. Chick peas are not a good source of iron.)

57. You are caring for a client who is receiving a bone marrow transplant to treat cancer. Important aspects of care to consider include: (Select all that apply.) 1. A patient receiving BMT is immune-suppressed and should be on reverse precautions. 2. BMT is done as a first line of treatment for children with cancer. 3. BMT should be given to the patient after they have received chemotherapy or radiation treatment so that his/her newly given healthy cells are not harmed. 4. Donor matches do not have to be exact and are easily found. 5. There are three major types of BMT, including allogeneic, autologous, and peripheral stem cell transplant (PSCT).

1, 3, 5 (1. Reverse precautions help the patient to not get infections from other individuals. 2. BMT is usually a last resort for treatment. 3. Chemotherapy and radiation kill cells, so the BMT should be done after this to keep the healthy cells alive. 4. Donor matches are difficult to find, and an exact match must be used. 5. The three types of BMT can benefit many different patients.)

8. What is included in neurologic checks for children of all ages with a brain tumor? 1. Papillary response, head circumference, vital signs 2. Motor activity, papillary response, vital signs 3. Level of consciousness, palpate fontanels, motor activity 4. Blood pressure, head circumference, level of consciousness

2 (1. A head circumference is not an indicated neurological check for all ages of children. 2. The indicators of the neurological system for all ages include a widening pulse pressure, papilledema, and the ability to move each extremity. 3. Vital signs need to be assessed in a child with a brain tumor to closely monitor changes in pulse pressures. Older children will have closed fontanels. 4. Head circumference is not measured in all children.)

54. A nurse educator is preparing an in-service meeting for new nurses on a pediatric oncology unit. The educator is planning to discuss cancer metastasis in patients with Hodgkin's Lymphoma. Which areas of the body should the nurse discuss as having high rates of metastasis with this disease? 1. Brain, stomach, and the low GI tract 2. Liver, spleen, bone marrow, and lungs 3. Liver, kidney, and bone marrow 4. Bone marrow and lungs

2 (1. A lower rate of metastasis occurs in these areas 2. These are the most common areas for metastasis to take place for Hodgkin's Lymphoma. 3. The kidney is not an area of high metastasis rates in children. 4. Other areas besides the bone marrow and lungs are part of the metastasis in Hodgkin's Lymphoma.)

30. What type of bone marrow transplant must have compatible human leukocyte antigen in both the donor and recipient? 1. Intravenous transplant 2. Allogeneic 3. Autologous 4. Peripheral stem cell transplant

2 (1. An intravenous transplant does not require compatible human leukocyte antigens. 2. Allogeneic transplants have to be compatible in order to decrease the risk for rejection. 3. Autologus does not have the same human leukocyte antigen and increases the chance for rejection. 4. Stem cell transplants must be from the child's own stem cells in order to have compatibility.)

50. The nurse is attempting to find the absolute neutrophil count for a 2-year-old boy. The child has the following laboratory results: WBC 1100 8 percent Bands 60 percent Segs The correct ANC would be: 1. 528. 2. 748. 3. 660. 4. 88.

2 ((8 percent Bands + 60 percent Segs) x1100 = 748 Feedback 1. Too low of a calculation 2. (8% Bands + 60% Segs)x1100 = 748 3. Too low of a calculation 4. Too low of a calculation)

17. The laboratory test ordered to determine the presence of the Human Immunodeficiency Virus antibodies is a: 1. Complete blood cell count. 2. Western blot immunoassay. 3. Bone marrow aspiration. 4. Biopsy of the tumor.

2 (1. A complete blood cell count is a common test to identify other types of infections and anemia. 2. The Western blot test confirms the presence of Human Immunodeficiency Virus antibodies. 3. A bone marrow aspiration is used in patients with cancer, not HIV. 4. A tumor biopsy is not a common test for identifying a patient with HIV.)

2. Classic hemophilia (hemophilia A) involves a deficiency in: 1. Factor V. 2. Factor VIII. 3. Factor IX. 4. Factor XIII.

2 (1. Factor V is not noted in hemophilia A. 2. Administration of Factor VIII, derived from pooled plasma, will increase the clotting ability of the body. 3. Factor IX is not an issue with hemophilia A. 4. Factor XIII is not a factor in hemophilia A.)

34. A 6-month-old patient is admitted for iron deficiency anemia. The nurse knows that the child was put at risk for developing the illness when the mother states: 1. "I have a house that does not have lead-based paint." 2. "He drinks milk instead of formula because it is cheaper." 3. "I make sure to monitor the amount of juice intake." 4. "I provide water in his bottles one time a day."

2 (1. Lead-based paint can lead to lead poisoning, not anemia. 2. A 6 month old is not able to store iron. Milk is not fortified with iron, thus creating the deficiency for the child. The child should remain on formula until at least 12 months of age. 3. Juice provides empty calories and nutrients and should not be given to an infant. 4. Water should not be given to an infant because it fills the stomach, and the child does not receive the needed nutrition from the formula.)

46. The mother of a 16-year-old teen with hemophilia calls the nurse triage and asks if it is appropriate to give her son a dose of NSAIDS to reduce his fever. The nurse knows that: 1. NSAIDS are the most effective treatment for fever reduction and should be given to the teen. 2. NSAIDS are not recommended because it may interfere with platelet formation. 3. NSAIDS are not recommended because they can cause Reyes's Syndrome. 4. NSAIDS are only effective when given with large amounts of water.

2 (1. NSAIDS can interfere with platelet formation in patients with hemophilia. 2. Instruction on not giving the medication because of the risk of platelet formation interference is needed. 3. At 16 years of age, Reye's Syndrome is decreased. NSAIDS interfere with the production of platelets for hemophiliacs. 4. NSAIDS do not need to be given with large amounts of water in order to be effective.)

6. Which of the following events places a preschool child at high risk for lead poisoning? 1. Using pencils and pens 2. Living in a home built before 1965 3. Drinking from the water fountain at school 4. Climbing on playground equipment

2 (1. Pencils and pens contain a low lead content. 2. Paint used in homes before 1965 contained lead, and the paint has not been removed. 3. Water is tested for lead levels and does not place the child at high risk. 4. Playground equipment has low levels of lead.)

31. Which of the following is an accurate description of the physiologic defect caused by anemia? 1. Presence of abnormal hemoglobin 2. Decreased oxygen carrying capacity of blood 3. Increased blood viscosity 4. Depressed hematopoietic system

2 (1. The abnormal hemoglobin may be present, but it contributes to anemia and is not caused by it. 2. The lack of oxygen carrying capacity is a physiological defect caused by the anemia. 3. Anemia causes the viscosity. 4. The decrease in the hematopoietic system is caused by the lack of production, not anemia.)

42. Parents of a 5-year-old with Sickle Cell disease are asking about care during their child's painful episodes. The nurse knows that the pain of Sickle Cell disease is caused by: 1. The lack of iron in the body. 2. The hypoxia that happens to the tissue, causing ischemia. 3. The red blood cell destruction. 4. A buildup of oxygen in the body.

2 (1. The lack of oxygen is the causative agent for pain. 2. The ischemia causes the painful episodes. 3. Red blood cells are malformation with this disease, not destroyed. 4. The transport of oxygen to the tissue causes the painful episodes.)

36. Typical signs of a child with iron deficiency anemia include all of the following except: 1. Tachycardia. 2. Bradycardia. 3. Thinning of hair. 4. Shortness of breath.

2 (1. The lack of red blood cells does not allow for enough oxygen carrying capacity. 2. Tachycardia is a sign, not bradycardia. 3. Thinning hair is a common sign of long-term iron deficiency anemia in children. 4. Shortness of breath is present because of the lack of oxygen carrying capacity of the red blood cells when the hemoglobin is low.)

39. A nurse is discussing the process of hematopoiesis with a new nurse. It is important for the new nurse to understand that: 1. Red blood cells live for less than five days. 2. Red blood cells are produced with erythropoietin and iron. 3. Red blood cells develop in the long bones. 4. Hemolysis of red blood cells occurs in the kidneys.

2 (1. The red blood cells' life span does not influence the hematopoiesis process. 2. Erythropoeitin and iron are included in the process of hematopoiesis. 3. Red blood cell production occurs in the bone marrow. 4. Hemolysis of red blood cells does not affect hematopoiesis.)

40. An 11-year-old child has been brought to the emergency room because the mother has noted petechiae on his elbows. When the nurse assesses the child, she notes that the boy has purpura on his legs. What action should be taken? 1. Notify the doctor of the medical emergency. 2. Assess if the child has had hematemesis. 3. An abuse investigation should be discussed with a social worker. 4. All of the above would be correct actions.

2 (1. This is not a medical emergency, but should be assessed. 2. The signs are consistent with hematemesis. 3. Because of where the marks are on the child's body, further assessment is needed before notifying a social worker. 4. The signs are consistent with hematemesis.)

1. Which of the following is a condition in which the normal hemoglobin is partially or completely replaced by abnormal hemoglobin? 1. Iron deficiency anemia 2. Sickle Cell anemia 3. Leukemia 4. Aplastic anemia

2 (1. Iron deficiency anemia occurs because there is not enough iron to support the production of hemoglobin. 2. Sickle Cell anemia has abnormal hemoglobin S. The deformed cell changes from a round shape to a sickle shape. 3. Leukemia a disease process that causes the destruction of hemoglobin. 4. Aplastic anemia occurs because the bone marrow is not producing enough red blood cells, making the patient anemic.)

41. The doctor has prescribed an injection of solu-medrol and occult of all stools for a child with acquired thrombocytopenia. Why should the nurse question the order? 1. Blood in the stools is rare with this illness. 2. Steroids are not an effective treatment. 3. Injections should not be given to a child with this condition. 4. None of the orders are appropriate for a child with this illness.

3 (1. Blood in the stools is possible with this disease process. 2. Steroids are a common treatment for thrombocytopenia. 3. Injection can further exacerbate the condition and should not be given to the child. 4. An injection should not be given to the child.)

4. A definitive diagnosis for leukemia is based on results of: 1. Fatigue and pallor. 2. A urinalysis. 3. A bone marrow aspirate. 4. A history and a physical.

3 (1. Fatigue and pallor are presumptive signs of leukemia. 2. A urinalysis does not give indications as to a diagnosis for leukemia. 3. The abnormal cells of leukemia are found in the bone marrow. 4. A history and a physical will help identify signs and symptoms, but not give a definitive diagnosis.)

16. Common adverse effects of chemotherapy are nausea and vomiting. As a result, the nurse should initiate which of the following nursing actions? 1. Remove food with a lot of color. 2. Wait until the nausea begins to administer the antiemetic as ordered. 3. Give an antiemetic 30 minutes before the start of chemotherapy. 4. Establish a nothing by mouth status during chemotherapy.

3 (1. Food in general may make the child have nausea and cause vomiting. 2. An antiemetic should be provided 30 minutes prior to chemotherapy to prevent the feelings of nausea and vomiting. 3. The onset of the antiemetic will occur with the start of chemotherapy and prevent nausea. 4. The patient can have food throughout chemotherapy if they feel well enough for food.)

53. The doctor has ordered for an 8 year old with a known diagnosis of leukemia to have a lumbar puncture. The nurse will need to do all of the following except: 1. Get informed consent from the parent/guardian. 2. Prepare the child by discussing what will occur using a teddy bear as a patient. 3. Set up a clean field for the procedure. 4. Provide pain medications prior to the lumbar puncture.

3 (1. Informed consent forms should be signed and placed in the chart prior to the procedure for the safety of the child. 2. A teddy bear can help describe what the procedure will be and decrease anxiety for the child. 3. A sterile field is needed for a lumbar puncture. 4. A pain medication to the puncture site will help keep the child calm and decrease anxiety.)

37. A mother asks the nurse why a reticulocyte test is performed on her daughter's blood. The nurse knows the reticulocyte test will indicate: 1. White blood cell production. 2. Hemoglobin production. 3. Red blood cell production. 4. Hematocrit production.

3 (1. Reticulocyte tests indicate red blood cell production. 2. The reticulocytes are the immature red blood cells that will indicate if enough is going to be produced. 3. The reticulocyte test is the smallest form that measures for red blood cell production. 4. The reticulocyte test is the smallest form that measures for red blood cell production.)

43. A child has been admitted with acute Sickle Cell crisis. During the assessment, the nurse would expect to see all of the following except: 1. Swollen joints. 2. Jaundice in the eyes. 3. An enlarged liver. 4. Severe pain in the abdomen.

3 (1. Swollen joints occur because of the ischemia and inflammatory response. 2. Jaundice occurs because of the lack of blood flow to the liver. 3. The liver does not enlarge. 4. Severe abdominal pain occurs because of the lack of oxygen carried to the tissue.)

35. The nurse has received hemoglobin and hematocrit levels for a 7-year-old patient. The results are HGB 9.0 and HCT 28 percent. These results indicate: 1. A normal HGB and HCT. 2. A high HGB and low HCT. 3. A low HGB and low HCT. 4. A low HGB and normal HCT.

3 (1. The HGB and HCT are low for a child this age. Intervention is needed. 2. The HGB is low, and intervention is needed. 3. The values are low. The family requires education on how to increase the hemoglobin and hematocrit levels. 4. The HCT is low, and an intervention is needed.)

45. Parents of a child with hemophilia want to have a second child. Genetic testing is recommended because: 1. The disease is carried by a dominant X-linked gene. 2. The disease is a mutation and has a low occurrence with subsequent pregnancies. 3. The X-linked recessive trait must be present in both parents, and a subsequent child may have the same disorder. 4. The Y-linked recessive trait causes the disease to occur and will happen in subsequent pregnancies.

3 (1. The disease is carried by an X-linked recessive gene. 2. The disease has a high occurrence if both parents are carriers. 3. The X-linked recessive trait must be present in both parents to occur. 4. The X-linked recessive trait is the carrier, not the Y-linked trait.)

44. A mother is asking questions about the type of diet her child should be receiving with the diagnosis of aplastic anemia. The nurse informs the mother that the child's diet should include: 1. Hamburgers and french fries. 2. Carrots and potatoes. 3. Turkey sandwiches and spinach salads. 4. Macaroni and hamburger casseroles.

3 (1. The fat content of the french fries should be avoided. 2. These are part of a healthy diet, but do not contain high levels of iron or protein. 3. The protein from the turkey and the iron from the spinach are appropriate for this child. 4. The macaroni has empty nutrients for a child with aplastic anemia.)

27. A nurse sees a new nurse on the floor handling chemotherapy medications without gloves or protective clothing. What should the nurse do first? 1. Talk about it with other employees at the nurses' station later that day. 2. Nothing. The new nurse is doing nothing wrong. 3. Remind the new nurse that it is not safe to handle these medications without protective clothing. 4. Report the new nurse to the supervisor for unsafe use of medications.

3 (1. The nurse needs to speak directly with the new nurse to teach her about the safe handling of chemotherapy agents. 2. The new nurse needs education on how to handle chemotherapy agents. 3. Reminding the new nurse will help facilitate learning on how to handle chemotherapy agents. 4. The issue should be directly discussed with the new nurse.)

20. A child with the diagnosis of AML is receiving chemotherapy. The platelet count is 10,000/mm3. The teaching plan for the caregiver should include: 1. Maintaining isolation precautions. 2. Visitors being limited with visiting time. 3. Using a soft toothbrush for mouth care. 4. An assessment of the vital signs every four hours.

3 (1. The platelet count is not in a range to need precautions at this time. 2. The patient may be tired, but visiting times do not need to be limited. 3. The soft toothbrush will minimize bleeding while performing mouth care. 4. Vital signs need to occur per protocol and as frequently as the patient's status renders.)

23. A child undergoing radiation therapy for cancer has a nursing diagnosis of risk for impaired skin integrity. What is a priority nursing action? 1. Cover the wound with a sterile dressing. 2. Use mild soap on the radiation area. 3. Use water to cleanse the area and leave markings on the skin. 4. Use antiseptic soap to cleanse the area.

3 1. The diagnosis is a risk, so an actual wound would not be present. 2. Soap may irritate the skin, and the markings are needed for future radiation treatments. 3. Water will not irritate the skin, and the markings are needed for future radiation treatments. 4. Antiseptic soap will irritate the skin, and the markings are needed for future radiation treatments.)

49. A mother has reported that her 18 month old has a lump on the abdominal area. She has noticed the lump while changing her daughter's diaper. A nurse should assess by using which measure(s)? 1. An abdominal circumference 2. Palpation and an abdominal circumference 3. Assessing the child's pain when the area is palpated 4. Assessing pain, palpation, and an abdominal circumference

4 (1. Palpation and pain assessment should also be conducted for a thorough exam. 2. A pain assessment is needed for the child. 3. An abdominal circumference should be performed. 4. Assessing pain, palpating, and measuring the abdominal circumference will aid in the nursing process for the child.)

12. A 12 year old is admitted with a Sickle Cell crisis. Which of the following is the priority nursing diagnosis? 1. High risk for dehydration 2. Impaired airway 3. Inappropriate grieving 4. Pain related to tissue ischemia

4 (1. The admitting diagnosis does not indicate if the child is dehydrated, thus this is not the proper diagnosis at this time. 2. The airway is not usually compromised in a child with a Sickle Cell crisis. 3. The Sickle Cell crisis may cause the child to grieve, but this is not the priority at this time. 4. The pain from the decreased oxygen carrying capacity of the cells causes distress. Comfort measures, including medication and warm, moist heat, must be considered.)

21. The child states, "I hate losing my hair" during chemotherapy. Which of the following interventions is important to the care of the child? 1. A wig similar to the usual hair style can be purchased. 2. Playing with others should include cancer survivors with hair loss. 3. Discuss the benefits of therapy with the child and caregivers. 4. Discuss feelings of the change and concerns with the child.

4 (1. Attempting to cover the head with a wig needs to be discussed with the child before attempting to purchase it. 2. The child should be playing with children that he/she feels most comfortable with. This does not address the concerns of the patient at this time. 3. This does not address the child's concerns and needs to focus on the body image issue at this time. 4. The child needs an opportunity to discuss feelings about the changes in body image.)

13. Jordan is 10 years old and has hemophilia. The discharge instructions should include teaching about participation in which of the following activities? 1. Football 2. Soccer 3. Baseball 4. Swimming

4 (1. Football has an increased risk for internal bleeding and should be avoided. 2. Soccer places the child at an increased risk for internal bleeding and should be avoided. 3. Baseball puts the child at increased risk for injury and should be avoided. 4. To lower the risk for internal bleeding, the child can participate in noncontact sports, such as swimming.)

38. The nurse is providing education about giving iron supplements to a 2-year-old child. The nurse should include none of the following except: 1. Giving the supplements one hour prior to letting the child drink milk. 2. Noting that diarrhea may be present at first. 3. Giving the supplements with vitamin D to increase absorption. 4. Stools may be black.

4 (1. Milk does not influence the absorption of iron. 2. Constipation is more common than diarrhea when taking iron supplements. 3. Vitamin D will not increase absorption. 4. Iron supplementation can cause black stools in toddlers.)

29. A 4-year-old boy comes into the emergency department with multiple bruises on his body, excessive nausea, headaches that lead to vomiting, persistent localized pain, and is very pale. Identify the one symptom that is not a cardinal sign of cancer. 1. Paleness 2. Bruises 3. Headaches 4. Excessive nausea

4 (1. Pale skin tone is common. 2. Bruises appear when no injury has occurred in children with cancer. 3. Excessive headaches can indicate tumor growth in children with cancer. 4. Excessive nausea is not common in children with cancer.)

22. The laboratory results of a child with AML indicate a white blood cell count of 500 with two percent bands. Which of the following responses is appropriate? 1. Administer the Hepatitis B vaccine as ordered. 2. Prepare for hemolytic reactions. 3. Visitors can bring flowers and gifts of fruit to the child. 4. Have people wash their hands prior to contact with the child.

4 (1. The child is at high risk for infection and vaccinations are not recommended. 2. The child is at risk for infection. 3. Flowers and fruit can bring in bacteria and should be avoided. 4. The child is at high risk of infection because he/she does not have an adequate white blood cell count of greater than 500, and the bands are immature white cells.)

24. A 7-year-old child has been hospitalized for treatment for leukemia. Which nursing action is most appropriate for the child's nutrition? 1. Offer only foods that the child likes. 2. Turn on the television for distraction while eating. 3. Offer juice or popsicles every two hours. 4. Have caregivers visit at mealtime.

4 (1. The child may not want the foods that are the most nutritious, thus requiring the offer of other foods. 2. The television should be off in order to encourage concentration on eating. 3. Juice and popsicles provide empty calories. A concentration on nutritious foods should be made. 4. The caregivers can offer emotional, social, and psychological support to enhance nutritional intake.)

5. When caring for a child with Wilm's tumor, which of the following nursing interventions would be most important? 1. Place child on neutropenic precautions. 2. Monitor bowel sounds in order to detect ileus. 3. Position in the high fowler's position in order to increase lung capacity. 4. Avoid palpation of the abdomen.

4 (1. The child will need neutropenic precautions if radiation or chemotherapy are provided. 2. A Wilm's tumor should not cause an ileus. 3. The lungs are not affected in a child with a Wilm's tumor, so it is not the most important intervention at this time. 4. The tumor is located in the abdomen and may be harmful to the child with palpation of the abdomen.)

51. A 7-year-old boy is scheduled to receive 3D conformal radiotherapy. The nurse knows that the parents understand the use of this type of radiation therapy when the father states: 1. "The standard margins will be targeted so that the tumor shrinks." 2. "This type of radiation is a last resort, so we should start planning for end-of-life care for our son." 3. "The radiation will occur while he is in surgery." 4. "The high doses of radiation will be concentrated on the tumor, and low doses of radiation will be concentrated on the surrounding tissue."

4 (1. This is a conventional focal radiation therapy. 2. Radiation is a common treatment for neoplasms. 3. Intraoperative radiotherapy occurs when the child is surgery. 4. The high doses of radiation concentrated on the tumor, and the low doses are concentrated on the surrounding tissue.)

60. Place the steps for accessing a central line in the correct sequence. ____1__ Perform hand hygiene ____2__ Access the injection cap with a syringe ____3__ Perform hand hygiene and assemble equipment __4____ Scrub injection cap ___5___ Let injection cap dry ___6___ Wear clean gloves __7____ Maintain Aseptic technique

7, 6, 2, 4, 5, 3, 1

True/ False 59. A child with a known diagnosis of HIV should not receive immunizations against common childhood illnesses.

F (1. The child should receive immunization on schedule to prevent further complications of the illness.)