Davis Pediatric Success Hematological/Oncology Disorders

Which of the following measures should the nurse teach the parent of a child with hemophilia to do fi rst if the child sustains an injury to a joint causing bleeding? 1. Give the child a dose of acetaminophen (Tylenol). 2. Immobilize the joint and elevate the extremity. 3. Apply heat to the area. 4. Administer factor per the home-care protocol.

4. Administration of factor should be the fi rst intervention if home-care transfusions have been initiated.

Which intervention should be implemented after a bone marrow aspiration? 1. Ask the child to remain in a supine position. 2. Place the child in an upright position for 4 hours. 3. Keep the child nothing by mouth for 6 hours. 4. Administer analgesics as needed for pain.

4. Children may experience minor discomfort after the procedure, and analgesics should be given as needed

A child with leukemia is receiving chemotherapy and is complaining of nausea. The nurse has been giving the scheduled antiemetic. Which of the following should the nurse do when the child is nauseated? 1. Encourage low-protein foods. 2. Encourage low-caloric foods. 3. Offer the child ' s favorite foods. 4. Offer cool, clear liquids.

4. Cool, clear liquids are better tolerated. Milk-based products cause secretions to be thick and can cause vomiting

Which of the following laboratory tests will be ordered to determine the presence of the human immunodefi ciency virus antigen in an infant whose mother is HIV + ? 1. CD4 cell count. 2. Western blot. 3. IgG levels. 4. p24 antigen assay.

4. Detection of HIV in infants is confi rmed by a p24 antigen assay, viral culture of HIV, or polymerase chain reaction.

The nurse is discharging a child who has just received chemotherapy for neuroblastoma. Which of the following statements made by the child ' s parent indicates a need for additional teaching? 1. "I will inspect the skin often for any lesions." 2. "I will do mouth care daily and monitor for any mouth sores." 3. "I will wash my hands before caring for my child." 4. "I will take a rectal temperature daily and report a temperature greater than 101°F (38.3°C) immediately to the health-care provider."

4. Monitoring the child ' s temperature and reporting it to the physician are important, but the temperature should not be taken rectally. The risk of injury to the mucous membranes is high. Rectal abscesses can occur in the damaged rectal tissue. The best method for taking the temperature is axillary, especially if the child has mouth sores.

Which of the following will be abnormal in a child with the diagnosis of hemophilia? 1. Platelet count. 2. Hemoglobin level. 3. White blood cell count. 4. Partial thromboplastin time (PTT).

4. The abnormal laboratory results in hemophilia are related to decreased clotting function. Partial thromboplastin time is prolonged.

The nurse is caring for a child with leukemia. The nurse should be aware that children being treated for leukemia may experience which of the following complications? Select all that apply. 1. Anemia. 2. Infection. 3. Bleeding tendencies. 4. Bone deformities. 5. Polycythemia.

1, 2, 3. 1. Anemia is caused by decreased production of red blood cells. 2. Infection risk in leukemia is secondary to the neutropenia. 3. Bleeding tendencies are from decreased platelet production.

A nurse is caring for a child with von Willebrand disease. The nurse is aware that which of the following is a clinical manifestation of von Willebrand disease? Select all that apply. 1. The child bruises easily. 2. Excessive menstruation. 3. The child has frequent nosebleeds. 4. Elevated creatinine levels. 5. Elevated blood pressure.

1, 2, 3. 1. Von Willebrand disease is a hereditary bleeding disorder characterized by defi ciency of or defect in a protein. The disorder causes adherence of platelets to damaged endothelium and a mild defi ciency of factor VIII. One of the manifestations of this disease is bleeding of the mucous membranes. 2. Excessive menstruation may be a manifestation of this disease. 3. Frequent nosebleeds are a common manifestation of this disease.

A child with hemophilia A fell and injured a knee while playing outside. The knee is swollen and painful. Which of the following measures should be taken to stop the bleeding? Select all that apply. 1. The extremity should be immobilized. 2. The extremity should be elevated. 3. Warm moist compresses should be applied to decrease pain. 4. Passive range-of-motion exercises should be administered to the extremity. 5. Factor VIII should be administered.

1, 2, 5 1. Measures are needed to induce vasoconstriction and stop the bleeding, including immobilization of the extremity. 2. Measures are needed to induce vasoconstriction and stop the bleeding. Treatment should include elevating the extremity. 5. Hemophilia A is a defi ciency in factor VIII, which causes delay in clotting when there is a bleed. Giving a dose of Factor VIII concentrate will assist in the clotting process.

The nurse is caring for a child who is receiving a transfusion of PRBCs. The nurse is aware that if the child has a hemolytic reaction to the blood, the signs and symptoms would include which of the following? Select all that apply. 1. Fever. 2. Rash. 3. Oliguria. 4. Hypotension. 5. Chills.

1, 3, 4. 1. Hemolytic reactions include fever, pain at insertion site, hypotension, renal failure, tachycardia, oliguria, and shock. 3. Hemolytic reactions include fever, pain at insertion site, hypotension, renal failure, tachycardia, oliguria, and shock. 4. Hemolytic reactions include fever, pain at insertion site, hypotension, renal failure, tachycardia, oliguria, and shock.

Which of the following best describes the action of chemotherapeutic agents used in the treatment of cancer in children? Select all that apply. 1. Suppress the function of normal lymphocytes in the immune system. 2. Are alkylating agents and are cell-specifi c. 3. Cause a replication of DNA and are cell-specifi c. 4. Interrupt cell cycle, thereby causing cell death. 5. Prednisone is a natural hormone.

1, 4, 5 1. All chemotherapy is immunosuppressive, because most childhood cancers affect the immune system. 4. Mitotic inhibitors, such as vincristine (Oncovin), stop cell division but can also damage cells in all phases of the cell cycle. 5. The corticosteroids are natural hormones that can be used to prevent nausea and allergic reactions. They are given with other chemotherapeutic agents.

A nurse educator is providing a teaching session for the nursing staff. Which of the following individuals is at greatest risk for developing beta-thalassemia (Cooley anemia)? 1. A child of Mediterranean descent. 2. A child of Mexican descent. 3. A child whose mother has chronic anemia. 4. A child who has a low intake of iron.

1. Beta-thalassemia is an inherited recessive disorder that is found primarily in individuals of Mediterranean descent. The disease has also been reported in Asian and African populations.

Which of the following should the nurse expect to administer to a child with ITP and a platelet count of 5000/mm 3 ? Select all that apply. 1. Platelets. 2. Intravenous immunoglobulin. 3. Packed red blood cells (PRBCs). 4. White blood cells. 5. Prednisolone.

2, 5 2. Intravenous immunoglobulin is given because the cause of platelet destruction is believed to be an autoimmune response to disease-related antigens. Treatment is usually supportive. Activity is restricted at the onset because of the low platelet count and risk for injury that could cause bleeding. 5. Treatment in the acute phase is often symptomatic, and prednisolone, IVIG, and anti-D antibody are often given. This tends to shorten the course because the disease tends to resolve over time. Focus on the cause of ITP and which cells are affected.

The nurse is caring for a child diagnosed with thalassemia major who is receiving the fi rst chelation therapy. What information should the nurse provide to the parent regarding the therapy? Select all that apply. 1. Decreases the risk of bleeding. 2. Eliminates excess iron. 3. Prevents further sickling of the red blood cells. 4. Provides an iron supplement. 5. Hydration is necessary for the process to be effective.

2, 5. 2. Chelation therapy is used to rid the body of excess iron stores that result from frequent blood transfusions 5. Hydration is necessary for the process to be effective.

Which test provides a defi nitive diagnosis of aplastic anemia? 1. Complete blood count with differential. 2. Bone marrow aspiration. 3. Serum IgG levels. 4. Basic metabolic panel.

2. Definitive diagnosis is determined from bone marrow aspiration, which demonstrates the conversion of red bone marrow to yellow, fatty marrow.

A nurse is caring for a 5-year-old with sickle cell vaso-occlusive crisis. Which of the orders should the nurse question? Select all that apply. 1. Position the child for comfort. 2. Apply hot packs to painful areas. 3. Give meperidine (Demerol) 25 mg intravenously every 4 hours as needed for pain. 4. Restrict oral fl uids. 5. Apply oxygen per nasal cannula to keep oxygen saturations above 94%.

3, 4, 5 3. Tissue hypoxia is very painful. Narcotics such as morphine are usually given for pain when the child is in a crisis. Meperidine (Demerol) should be avoided because of the risk of Demerol-induced seizures. 4. The child should receive hydration because when the child is in crisis, the abnormal S-shaped red blood cells clump, causing tissue hypoxia and pain. 5. Oxygen is of little value unless the tissue is hypoxic. The objective of treatment is to minimize hypoxia.

An 18-month-old male is brought to the clinic by his mother. His height is in the 50th percentile, and his weight is in the 80th percentile. The child is pale. The physical examination is normal, but his hematocrit level is 20%. Which of the following questions should assist the nurse in making a diagnosis? Select all that apply. 1. "How many bowel movements a day does your child have?" 2. "How much did your baby weigh at birth?" 3. "What does your child eat every day?" 4. "Has the child been given any new medications?" 5. "How much milk does your child drink per day?"

3, 5 3. A diet history is necessary to determine the nutritional status of the child and whether the child is getting suffi cient sources of iron. 5. By asking how much milk the child consumes, the nurse can determine whether the child is fi lling up on milk and then not wanting to take food.

Which of the following is the most common opportunistic infection in children infected with human immunodefi ciency virus (HIV)? 1. CMV. 2. Encephalitis. 3. Meningitis. 4. Pneumocystic pneumonia.

4. Pneumocystis jiroveci pneumonia is the most common opportunistic infection that can occur in HIV-infected children, and such children are treated prophylactically for this.

Which of the following activities should a nurse suggest for a client diagnosed with hemophilia? Select all that apply. 1. Swimming. 2. Golf. 3. Hiking. 4. Fishing. 5. Soccer.

1, 2, 3, 4 1. Children with hemophilia should be encouraged to take part in noncontact activities that allow for social, psychological, and physical growth, such as swimming. 2. Children with hemophilia should be encouraged to take part in noncontact activities that allow for social, psychological, and physical growth, such as golf. 3. Children with hemophilia should be encouraged to take part in noncontact activities that allow for social, psychological, and physical growth, such as hiking. 4. Children with hemophilia should be encouraged to take part in noncontact activities that allow for social, psychological, and physical growth, such as fishing

Which of the following can lead to a possible diagnosis of human immunodefi ciency virus (HIV) in a child? Select all that apply. 1. Repeated respiratory infections. 2. Intermittent diarrhea. 3. Excessive weight gain. 4. Irregular heartbeat. 5. Poor weight gain.

1, 2, 5 1. Symptoms of HIV include frequent respiratory infections. The symptoms present based on the underlying cellular immunodefi ciency-related disease. 2. Symptoms of HIV include intermittent diarrhea. The symptoms present based on the underlying cellular immunodeficiency-related disease. 5. Symptoms of HIV include poor weight gain.

Which of the following measures should be implemented for a child with von Willebrand disease who has a nosebleed? 1. Apply pressure to the nose for at least 10 minutes. 2. Have the child lie supine and quiet. 3. Avoid packing of the nostrils. 4. Encourage the child to swallow frequently.

1. Applying pressure to the nose may stop the bleeding. In von Willebrand disease, there is an increased tendency to bleed from mucous membranes, leading to nosebleeds commonly from the anterior part of the nasal septum.

The parent of a 2-year-old who is HIV + questions the nurse about placing the child in day care. Which of the following is the best response? 1. The child should not go to day care until older, because there is a high risk for transmission of the disease. 2. The child can go to day care without restrictions and should be allowed to participate in all activities. 3. The child can go to day care but should avoid physical activity. 4. The child may go to day care, but the parent must inform all the parents at the day care that the child is HIV + .

2. The child can attend day care without any limitations but should not attend with a fever

A nurse is doing discharge education with a parent who has a child with betathalassemia (Cooley anemia). The nurse informs the parent that the child is at risk for which of the following conditions? 1. Hypertrophy of the thyroid. 2. Polycythemia vera. 3. Thrombocytopenia. 4. Chronic hypoxia and iron overload.

4. In beta-thalassemia, there is increased destruction of red blood cells, causing anemia. This results in chronic anemia and hypoxia. The children are treated with multiple blood transfusions, which can cause iron overload and damage to major organs.

Prednisone is given to children who are being treated for leukemia. Why is this medication given as part of the treatment plan? 1. Enhances protein metabolism. 2. Enhances sodium excretion. 3. Increases absorption of the chemotherapy. 4. Destroys abnormal lymphocytes.

4. Prednisone is used in many of the treatment protocols for leukemia because there is abnormal lymphocyte production. Prednisone is thought to destroy abnormal lymphocytes.

The parent of a teen with a diagnosis of Hodgkin disease asks what the child ' s prognosis will be with treatment. What information should the nurse give to the parent and child? 1. Clinical staging of Hodgkin disease will determine the treatment; long-term survival for all stages of Hodgkin disease is excellent. 2. There is a considerably better prognosis if the client is diagnosed early and is less than 5 years of age. 3. The prognosis for Hodgkin disease depends on the type of chemotherapy. 4. The only way to obtain a good prognosis is by chemotherapy and bone marrow transplant.

1. Long-term survival for all stages of Hodgkin disease is excellent. Early-stage disease can have a survival rate greater than 90%, with advanced stages having rates between 65% and 75%.

Which of the following describes idiopathic thrombocytopenia purpura (ITP)? Select all that apply. 1. ITP is a congenital hematological disorder. 2. ITP causes excessive destruction of platelets. 3. Children with ITP have normal bone marrow. 4. Platelets are small in ITP. 5. Purpura is observed in ITP.

2, 3, 5 2. ITP is characterized by excessive destruction of platelets. 3. The bone marrow is normal in children with ITP 5. ITP is characterized by purpura, which are areas of hemorrhage under the skin.

The nurse is caring for a 10-year-old with leukemia who is receiving chemotherapy. The child is on neutropenic precautions. Friends of the child come to the desk and ask for a vase for the fl owers they have brought with them. Which of the following is the best response? 1. "I will get you a special vase that we use on this unit." 2. "The fl owers from your garden are beautiful but should not be placed in the room at this time." 3. "As soon as I can wash a vase, I will put the fl owers in it and bring it to the room." 4. "Get rid of the fl owers immediately. You could harm the child."

2. A neutropenic client should not have fl owers in the room because the fl owers may harbor Aspergillus or Pseudomonas aeruginosa. Neutropenic children are susceptible to infection. Precautions need to be taken so that the child does not come in contact with any potential sources of infection. Fresh fruits and vegetables can also harbor molds and should be avoided. Telling the friend that the fl owers are beautiful but that the child cannot have them is a tactful way not to offend the friend.

The nurse is taking care of a child with sickle cell disease. The nurse is aware that which of the following problems is (are) associated with sickle cell disease? Select all that apply. 1. Polycythemia. 2. Hemarthrosis. 3. Aplastic crisis. 4. Thrombocytopenia. 5. Vaso-occlusive crisis.

3, 5 3. Aplastic crisis, temporary cessation of red blood cell production, is associated with sickle cell anemia. 5. Vaso-occlusive crisis is the most common problem in children with sickle cell disease.

The parent of a child diagnosed with Wilms tumor asks the nurse what the treatment plan will be. The nurse explains the usual protocol for this condition. Which information should the nurse give to the parent? 1. The child will have chemotherapy and, after that has been completed, radiation. 2. The child will need to have surgery to remove the tumor. 3. The child will go to surgery for removal of the tumor and the kidney and will then start chemotherapy. 4. The child will need radiation and later surgery to remove the tumor.

3. Combination therapy of surgery and chemotherapy is the primary therapeutic management. Radiation is done depending on clinical stage and histological pattern.

A teen is seen in clinic for a possible diagnosis of Hodgkin disease. The nurse is aware that which of the following symptoms should make the health-care provider suspect Hodgkin disease? 1. Fever, fatigue, and pain in the joints. 2. Anorexia with weight loss. 3. Enlarged, painless, and movable lymph nodes in the cervical area. 4. Enlarged liver with jaundice.

3. Enlarged, painless, and movable lymph nodes in the cervical area are the most common presenting manifestations of Hodgkin disease

Which of the following should be done to protect the central nervous system from the invasion of malignant cells in a child newly diagnosed with leukemia? 1. Cranial and spinal radiation. 2. Intravenous steroid therapy. 3. Intrathecal chemotherapy. 4. High-dose intravenous chemotherapy.

3. Giving chemotherapy via lumbar puncture allows the drugs to get to the brain and helps prevent metastasis of the disease.

Where is the primary site of origin of the tumor in children who have neuroblastoma? 1. Bone. 2. Kidney. 3. Abdomen. 4. Liver.

3. Neuroblastoma tumors originate from embryonic neural crest cells that normally give rise to the adrenal medulla and the sympathetic nervous system. The majority of the tumors arise from the adrenal gland or from the retroperitoneal sympathetic chain. Therefore, the primary site is within the abdomen

The nurse is caring for a child who is receiving extensive radiation as part of the treatment for Hodgkin disease. Which intervention should be implemented? 1. Administer pain medication prior to the child ' s going to radiation therapy. 2. Assess the child for neuropathy since this is a common side effect. 3. Provide adequate rest, because the child may experience excessive malaise and lack of energy. 4. Encourage the child to eat a low-protein diet while on radiation therapy.

3. The most common side effect is extensive malaise, which may be from damage to the thyroid gland, causing hypothyroidism

Which of the following measures should the nurse implement to help with the nausea and vomiting caused by chemotherapy? Select all that apply. 1. Give an antiemetic 30 minutes prior to the start of therapy. 2. Continue the antiemetic as ordered until 24 hours after the chemotherapy is complete. 3. Remove food that has a lot of odor. 4. Keep the child on a nothing-by-mouth status. 5. Wait until the nausea begins to start the antiemetic.

1, 2, 3 1. The first dose should be given 30 minutes prior to the start of the therapy. 2. Antiemetic should be administered around the clock until 24 hours after the chemotherapy is completed. 3. It is also helpful to remove foods with odor so that the smell of the food does not make the child nauseated.

Which of the following can be a manifestation of leukemia in a child? Select all that apply. 1. Leg pain. 2. Fever. 3. Excessive weight gain. 4. Bruising. 5. Enlarged lymph nodes.

1, 2, 4, 5 1. The proliferation of cells in the bone marrow can cause leg pain. 2. Fever is a result of the neutropenia. 4. A decrease in platelets causes the bruising. 5. The lymph nodes are enlarged by the infi ltration of leukemic cells.

A nurse is caring for a 15-year-old who has just been diagnosed with non-Hodgkin lymphoma. Which of the following should the nurse include in teaching the parents about this lymphoma? Select all that apply. 1. The malignancy originates in the lymphoid system. 2. The presence of Reed-Sternberg cells in the biopsy is considered diagnostic. 3. Mediastinal involvement is typical. 4. The disease is diffuse rather than nodular. 5. Treatment includes chemotherapy and radiation.

1, 3, 4, 5 1. Non-Hodgkin disease originates in the lymphoid system. 3. Mediastinal involvement is typical. 4. The disease is diffuse rather than nodular. 5. Treatment includes chemotherapy and radiation.

Which of the following factors need(s) to be included in a teaching plan for a child with sickle cell disease? Select all that apply. 1. The child needs to be taken to a physician when sick. 2. The parent should make sure the child sleeps in an air-conditioned room. 3. Emotional stress should be avoided. 4. It is important to keep the child well hydrated. 5. It is important to make sure the child gets adequate nutrition.

1, 3, 4, 5 1. Seek medical attention for illness to prevent the child from going into a crisis. 3. Stress can cause a depressed immune system, making the child more susceptible to infection and crisis. Parents and children are advised to avoid stress. 4. The child needs good hydration and nutrition to maintain good health. 5. The child needs good hydration and nutrition to maintain good health

The nurse is caring for a child with sickle cell disease who is scheduled to have a splenectomy. What information should the nurse explain to the parents regarding the reason for a splenectomy? 1. To decrease potential for infection. 2. To prevent splenic sequestration. 3. To prevent sickling of red blood cells. 4. To prevent sickle cell crisis.

2. Splenic sequestration is a life-threatening situation in children with sickle cell disease. Once a child is considered to be at high risk of splenic sequestration or has had this in the past, the spleen will be removed.

A 10-year-old with severe factor VIII defi ciency falls, injures an elbow, and is brought to the ED. The nurse should prepare which of the following? 1. An IM injection of factor VIII. 2. An IV infusion of factor VIII. 3. An injection of desmopressin. 4. An IV infusion of platelets

2. The child is treated with an IV infusion of factor VIII to replace the missing factor and help stop the bleeding

What are the clinical manifestations of non-Hodgkin lymphoma? 1. Basically the same as those in Hodgkin disease. 2. Depends on the anatomical site and extent of involvement. 3. Nausea, vomiting, abdominal pain. 4. Behavior changes, jaundice, dry mouth.

2. The clinical manifestations include symptoms of involvement. Rarely is a single sign or symptom diagnostic. Metastasis to the bone marrow or central nervous system may produce manifestations of leukemia

Which of the following is the most effective treatment for pain in a child with sickle cell crisis? Select all that apply. 1. Meperidine (Demerol). 2. Aspirin. 3. Morphine. 4. Behavioral techniques. 5. Acetaminophen (Tylenol) with codeine.

3, 4, 5. 3. Morphine is the drug of choice for a child with sickle cell crises. Usually the child is started on oral doses of acetaminophen (Tylenol) with codeine. When that is not suffi cient to alleviate pain, stronger narcotics are prescribed, such as morphine. Ketorolac (Toradol) may be indicated for short-term use for moderate-severe pain. 4. Behavioral techniques such as positive self-talk, relaxation, distraction, and guided imagery are helpful when pain is occurring. 5. Usually the child is started on oral doses of acetaminophen (Tylenol) with codeine when pain is described as mild to moderate

The nurse expects which of the following clinical manifestations in a child diagnosed with SCID? 1. Prolonged bleeding. 2. Failure to thrive. 3. Fatigue and malaise. 4. Susceptibility to infection

4. SCID is characterized by an absence of cell-mediated immunity, with the most common clinical manifestation being infection in children from age 3 months. These children do not usually recover from these infections.

School-age children with cancer often have a body image disturbance related to hair loss, moon face, or debilitation. Which of the following interventions is (are) most appropriate? Select all that apply. 1. Encourage them to wear a wig similar to their own hairstyle. 2. Emphasize the benefi ts of the therapy they are receiving. 3. Have them play only with other children with cancer. 4. Use diversional techniques to avoid discussing changes in the body because of the chemotherapy. 5. Help them fi nd a "special friend" who understands what they are experiencing.

1, 5 1. Wearing a wig is a good way for the child to keep personal identity despite the loss of hair. 5. Children with cancer and body-image changes oftentimes need assistance in expressing themselves, which a "special friend" can help with.

Which of the following confi rms a diagnosis of Hodgkin disease in a 15-year-old? 1. Reed-Sternberg cells in the lymph nodes. 2. Blast cells in the blood. 3. Lymphocytes in the bone marrow. 4. VMA in the urine.

1. A lymph node biopsy is done to confi rm a histological diagnosis and staging of Hodgkin disease. The presence of Reed- Sternberg cells is characteristic of the disease.

A child diagnosed with leukemia is receiving allopurinol (Zyloprim) as part of the treatment plan. The parents ask why their child is receiving this medication. What information about the medication should the nurse provide? 1. Helps reduce the uric acid level caused by cell destruction. 2. Helps make the chemotherapy more effective. 3. Helps reduce the nausea and vomiting associated with chemotherapy. 4. Helps decrease pain in the bone marrow

1. Allopurinol (Zyloprim) reduces serum uric acid. When there is lysis of cells from chemotherapy, there will be an increase in serum uric acid.

The nurse is caring for a child with a diagnosis of ALL who is receiving chemotherapy. The nurse notes that the child ' s platelet count is 20,000/mm 3 . Based on this laboratory fi nding, what information should the nurse provide to the child and parents? 1. A soft toothbrush should be used for mouth care. 2. Isolation precautions should be started immediately. 3. The child ' s vital signs, including blood pressure, should be monitored every 4 hours. 4. All visitors should be discouraged from coming to see the family.

1. Because the platelet count is decreased, there is a signifi cant risk of bleeding, especially in soft tissue. The use of the soft toothbrush should help prevent bleeding of the gums.

Which of the following is correct regarding prognostic factors for determining survival for a child newly diagnosed with ALL? 1. The initial white blood cell count on diagnosis. 2. The race of the child. 3. The amount of time needed to initiate treatment. 4. Children aged 12 to 15 years.

1. Children with a normal or low white blood cell count who do not have non-T, non-B acute lymphoblastic leukemia and who are CALLA-positive have a much better prognosis than those with high cell counts or other cell types.

The nurse is caring for a child with sickle cell disease who is scheduled to have an exchange transfusion. What information should the nurse teach the family? 1. The procedure is done to prevent further sickling during a vaso-occlusive crisis. 2. The procedure reduces side effects from blood transfusions. 3. The procedure is a routine treatment for sickle cell crisis. 4. Once the child ' s spleen is removed, it is not necessary to do exchange transfusions.

1. Exchange transfusion reduces the number of circulating sickle cells and slows down the cycle of hypoxia, thrombosis, and tissue ischemia.

The parent of a 4-year-old brings the child to the clinic and tells the nurse the child ' s abdomen is distended. After a complete examination, a diagnosis of Wilms tumor is suspected. Which of the following is most important when doing a physical examination on this child? 1. Avoid palpation of the abdomen. 2. Assess the urine for the presence of blood. 3. Monitor vital signs, especially the blood pressure. 4. Obtain an accurate height and weight.

1. Palpating the abdomen of the child in whom a diagnosis of Wilms tumor is suspected should be avoided because manipulation of the abdomen may cause seeding of the tumor.

The nurse is caring for a child being treated for ALL. Laboratory results indicate that the child has a white blood cell count of 5000/mm 3 with 5% polys and 3% bands. Which of the following analyses is most appropriate? 1. The absolute neutrophil count is 400/mm 3 , and the child is neutropenic. 2. The absolute neutrophil count is 800/mm 3 , and the child is neutropenic. 3. The absolute neutrophil count is 4000/mm 3 , and the child is not neutropenic. 4. The absolute neutrophil count is 5800/mm 3 , and the child is not neutropenic.

1. The calculated absolute neutrophil count is 400/mm 3 (0.08 Å~ 5000), and the child is neutropenic because the count is less than 500/mm 3 .

Which of the following is a reason to perform a lumbar puncture on a child with a diagnosis of leukemia? Select all that apply. 1. Rule out meningitis. 2. Assess the central nervous system for infiltration. 3. Give intrathecal chemotherapy. 4. Determine increased intracranial pressure. 5. Stage the leukemia.

2, 3 2. A lumbar puncture is done to determine whether the cancer cells have entered the CNS, but this would not be routine unless the child was symptomatic. 3. Chemotherapy can also be given through a lumbar puncture (spinal tap).

The nurse receives a call from a parent of a child with leukemia in remission. The parent says the child has been exposed to chickenpox and has never had it. Which of the following responses is most appropriate for the nurse? Select all that apply. 1. "You need to monitor the child ' s temperature frequently and call back if the temperature is greater than 101°F (38.3°C)." 2. "The child has had two varicella immunizations as an infant but is no longer immune after chemotherapy." 3. "You need to bring the child to the clinic for a varicella immunoglobulin vaccine." 4. "Your child will need to be isolated for the next 2 weeks." 5. "Your child may develop chicken pox lesions about 14 to 21 days after exposure."

2, 3 2. Chickenpox exposure is a real concern for a child who is immunocompromised, and action needs to be taken. 3. The child should receive varicella zoster immune globulin within 96 hours of the exposure.

Which of the following is the best method to prevent the spread of infection to an immunosuppressed child? 1. Administer antibiotics prophylactically to the child. 2. Have people wash their hands prior to contact with the child. 3. Assign the same nurses to care for the child each day. 4. Limit visitors to family members only.

2. Hand washing is the best method to prevent the spread of germs and protect the child from infection.

The parent of a child with hemophilia is asking the nurse what caused the hemophilia. Which is the nurse ' s best response? 1. It is an X-linked dominant disorder. 2. It is an X-linked recessive disorder. 3. It is an autosomal dominant disorder. 4. It is an autosomal recessive disorder

2. Hemophilia is transmitted as an X-linked recessive disorder. About 60% of children have a family history of hemophilia. The usual transmission is by a female with the trait and an unaffected male.

A nurse instructs the parent of a child with sickle cell disease about factors that might precipitate a pain crisis in the child. Which of the following factors identifi ed by the parent as being able to cause a pain crisis indicates a need for further instruction? 1. Infection. 2. Overhydration. 3. Stress at school. 4. Cold environment.

2. Overhydration does not cause a crisis.

A child has completed treatment for leukemia and comes to the clinic for a checkup with the parents. The parents express to the nurse that they are glad their child has been cured of cancer and is safe from getting cancer later in life. Which of the following should the nurse consider in responding? 1. Childhood cancer usually instills immunity to all other cancers. 2. Children surviving one cancer are at higher risk for a second cancer. 3. The child may have a remission of the leukemia but is immune to all other cancers. 4. As long as the child continues to take steroids, there will be no other cancers

2. The most devastating late effect of leukemia treatment is development of secondary malignancy.

When caring for a child with lymphoma, the nurse needs to be aware of which of the following? 1. The same staging system is used for lymphoma and Hodgkin disease. 2. Aggressive chemotherapy with central nervous system prophylaxis will give the child a good prognosis. 3. All children with lymphoma need a bone marrow transplant for a good prognosis. 4. Despite high-dose chemotherapy, the prognosis is very poor for most children.

2. The use of aggressive combination chemotherapy has a major impact on the survival rates for children with a diagnosis of lymphoma. Because there is usually bone marrow involvement, there is a need for central nervous system prophylaxis.

A 5-year-old is admitted to the hospital with complaints of leg pain and fever. On physical examination, the child is pale and has bruising over various areas of the body. The health-care provider suspects that the child has ALL. The nurse informs the parent that the diagnosis will be confi rmed by which of the following? 1. Lumbar puncture. 2. White blood cell count. 3. Bone marrow aspirate. 4. Bone scan.

3. The diagnostic test that confi rms leukemia is microscopic examination of the bone marrow aspirate.

The nurse is instructing the parent of a child with HIV about immunizations. Which of the following should the nurse tell the parent? Select all that apply. 1. Hepatitis B vaccine will not be given to this child. 2. Members of the family should be cautioned not to receive the varicella vaccine. 3. The child will need to have a Western blot test done prior to all immunizations. 4. Pneumococcal and infl uenza vaccines are recommended. 5. Meningitis immunization.

4, 5 4. Immunizations against childhood illnesses are recommended for children exposed to or infected with HIV. Pneumococcal and infl uenza vaccines are recommended at their scheduled times 5. Meningococcal immunizations can be administered on the regular schedule.

The most important reason health-care providers prescribe a combination of antiretroviral drugs to children with HIV is to delay: 1. Progression to AIDS. 2. Enable treatment of multiple symptoms. 3. Recurrence of symptoms. 4. Drug resistance

4. A combination of antiretroviral medications is prescribed for a child who is HIV positive to delay development of drug resistance. HIV drugs work on different stages of the HIV life cycle to prevent reproduction of new virus particles.