Hematological/Immune/Cancer

The nurse is caring for a thirteen-year-old female who has been newly diagnosed with a neuroblastoma. The adolescent and her parents ask the nurse about the surgery and chemotherapy phases of treatment. What are correct responses from the nurse? Select all that apply. 1. "After the surgery is over and you go home, it will be important to monitor your daughter's temperature and incision site." 2. "You will not be allowed to eat a regular diet for several weeks following surgery." 3. "Your healthcare team will do their best to keep you and your parents well informed and involved with your care before, during, and after your surgery and chemotherapy." 4. "Because your child will be receiving chemotherapy she will not have to have an I.V." 5. "You and your child will learn about how to care for a central line."

1. "After the surgery is over and you go home, it will be important to monitor your daughter's temperature and incision site." 3. "Your healthcare team will do their best to keep you and your parents well informed and involved with your care before, during, and after your surgery and chemotherapy." 5. "You and your child will learn about how to care for a central line."

Treatment for a 4-year-old with HSP includes which of the following? Select all that apply. 1. Administer NSAIDS for pain. 2. Monitor blood pressure. 3. Monitor for renal involvement. 4. Position of comfort for joint pain. 5. Apply a cream for the maculopapular rash.

1. Administer NSAIDS for pain. 2. Monitor blood pressure. 3. Monitor for renal involvement.

Which are the common causes of acquired aplastic anemia? Select all that apply. 1. Certain anticonvulsants medications. 2. Certain chemotherapeutic agents. 3. Idiopathic causes. 4. Prednisolone. 5. Indoor wall paints.

1. Certain anticonvulsants medications. 2. Certain chemotherapeutic agents. 3. Idiopathic causes.

A 7-year-old female returns to school after yearlong radiation treatments due to a brain tumor. She seems to have difficulty grasping the concepts in most of her classes. Which plan should the school nurse institute? 1. Create an individualized education plan (IEP) and organize a meeting with the child's teachers. 2. Advise the parents to keep the child at home and ask social work to arrange tutoring 3. Inform the child she must make up all of her schoolwork within 1 month 4. Offer homeschooling for 1 to 2 week to allow slow integration back to school

1. Create an individualized education plan (IEP) and organize a meeting with the child's teachers.

The nurse is caring for a child who has a decreased level of oxygen-carrying blood cells. Which blood cell is deficient? 1. Erythrocytes 2. Leukocytes 3. Thrombocytes 4. Granulocytes

1. Erythrocytes

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. Fever. 3. Oliguria. 4. Hypotension.

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. Helps reduce the uric acid level caused by cell destruction.

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. Swimming. 2. Golf. 3. Hiking. 4. Fishing.

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/mm3 with 5% polys and 3% bands. Which of the following analyses is most appropriate? 1. The absolute neutrophil count is 400/mm3, and the child is neutropenic. 2. The absolute neutrophil count is 800/mm3, and the child is neutropenic. 3. The absolute neutrophil count is 4000/mm3, and the child is not neutropenic. 4. The absolute neutrophil count is 5800/mm3, and the child is not neutropenic.

1. The absolute neutrophil count is 400/mm3, and the child is neutropenic. *The calculated absolute neutrophil count is 400/mm3 (0.08 × 5000), and the child is neutropenic because the count is less than 500/mm3.

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. The child needs to be taken to a physician when sick. 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.

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. The extremity should be immobilized. 2. The extremity should be elevated. 5. Factor VIII should be administered.

A child being treated with dexamethasone in conjunction with other chemotherapy for treatment of leukemia. On a follow-up visit, the pediatric oncology clinic nurse expects which as a side-effect? 1. Weight gain 2. Decreased blood pressure 3. Anorexia 4. Improved mood

1. Weight gain

When providing guidance to a child with spina bifida with a known allergy to latex, the nurse should make the suggestion that the following items may contain latex. Select all that apply. 1. balloons 2. rubber bands 3. tennis balls 4. baby blankets 5. chewing gum

1. balloons 2. rubber bands 3. tennis balls 5. chewing gum

When discussing care requirements for a child with human immunodeficiency virus (HIV infection), the nurse discusses infection control precautions. Which statement indicates the need for further instruction? 1. "I should make sure to wash my hands frequently." 2. "The temperature should be taken rectally every day." 3. "When I preform diaper changes, I will wear gloves." 4. "I will not allow anyone with colds to visit."

2. "The temperature should be taken rectally every day." *increased risk for infection

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

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

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. Children surviving one cancer are at higher risk for a second cancer.

The nurse is caring for a child diagnosed with thalassemia major who is receiving the first 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. Eliminates excess iron. 5. Hydration is necessary for the process to be effective.

Which of the following should the nurse expect to administer to a child with ITP and a platelet count of 5000/mm3? Select all that apply. 1. Platelets. 2. Intravenous immunoglobulin. 3. Packed red blood cells. 4. White blood cells. 5. Prednisolone.

2. Intravenous immunoglobulin. 5. Prednisolone.

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 identified 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.

A 3-year-old child has neutropenia as noted by a white blood cell count of 2200 mm due to the diagnosis of aplastic anemia. When caring for the child, the family and nursing care should focus on which of the following? 1. Preventing bruising 2. Preventing infection 3. Preventing fatigue 4. Developmental issues

2. Preventing infection

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. To prevent splenic sequestration.

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

3. Abdomen.

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. Aplastic crisis. 5. Vaso-occlusive crisis.

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 confirmed by which of the following? 1. Lumbar puncture. 2. White blood cell count. 3. Bone marrow aspirate. 4. Bone scan.

3. Bone marrow aspirate.

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.

A preschooler presents to the emergency department with the following signs/symptoms: bilateral leg purpura, eyelid edema, Edema and arthralgia of left knee, and mild bloody diarrhea. The most likely diagnosis is? 1. Inflammatory bowel disease. 2. Rheumatic fever. 3. HSP. 4. ALL.

3. HSP.

A child with leukemia has a WBC count of 10,000/microliter, RBC count of 5(x10^12/L), and platelets of 20,000/microliter. The child is also fairly active, visiting the playroom twice a day. When planning this child's care, which risk should the nurse consider most significant? 1. Infection 2. Anemia 3. Hemorrhage 4. Pain

3. Hemorrhage

The nurse and family take special precautions when caring for a child with any bleeding disorder. Which statement indicates teaching about these precautions as not effective? 1. "My child will have a saline lock if frequent blood draws are anticipated." 2. "I should provide gentle mouth care at least every 3 hours." 3. "There is a paper tape that will be easier on my child's skin." 4. "I will make sure my child has a rectal temperature every 4 hours."

4. "I will make sure my child has a rectal temperature every 4 hours." *perforation of the anus or rectum can cause bleeding and infection

A nurse is doing discharge education with a parent who has a child with beta-thalassemia (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. Chronic hypoxia and iron overload. *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.

The nurse is teaching a family about ways to minimize contact with allergies. What items should the nurse include in the teaching? 1. Keeping pets outside 2. Using cloth covers on mattresses and pillows 3. Avoiding hardwood floors in the home 4. Cleaning frequently with moist cloths

4. Cleaning frequently with moist cloths *pets should be kept outside the child's room *plastic covers on mattresses and pillows *carpet should be avoided **moist cloth and mops, removes dust

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. Destroys abnormal lymphocytes.

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. Partial thromboplastin time (PTT). *The abnormal laboratory results in hemophilia are related to decreased clotting function. Partial thromboplastin time is prolonged.

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. Apply pressure to the nose for at least 10 minutes. *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.

Which of the following describes 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. Petechiae are common in ITP.

2. ITP causes excessive destruction of platelets. 3. Children with ITP have normal bone marrow. 5. Petechiae are common in ITP.

When developing a plan of care for a child who is receiving chemotherapy for acute lymphocytic leukemia, which indicates the priority intervention? 1. Weigh weekly 2. Call physician if urine specific gravity >1.020 3. Provide antiemetics only every 8 hours 4. Administer intravenous fluids

4. Administer intravenous fluids

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. Have people wash their hands prior to contact with the child.

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. Anemia. 2. Infection. 3. Bleeding tendencies.

The nurse is caring for a child who is experiencing respiratory difficulty following the administration of a medication. What drug should the nurse initially plan to administer to this child if indicated? 1. Epinephrine 2. Prednisone 3. Ranitidine 4. Diphenhydramine

1. Epinephrine *prednisone & oxygen after epinephrine *diphenhydramine given if epinephrine was not available

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. Depends on the anatomical site and extent of involvement.

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 benefits 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 find a "special friend" who understands what they are experiencing.

1. Encourage them to wear a wig similar to their own hairstyle. 5. Help them find a "special friend" who understands what they are experiencing.

An eight-teen month-old is admitted to the pediatric unit with a platelet count of 10,000 uL. Nursing care should include which of the following? Select all that apply. 1. Encouraging active play to promote development while in the hospital 2. Careful assessment for bleeding and new bruising 3. Teaching related to the treatment plan for the child 4. Axillary temperature assessment 5. Monitor the child's neurological status

2. Careful assessment for bleeding and new bruising 3. Teaching related to the treatment plan for the child 4. Axillary temperature assessment 5. Monitor the child's neurological status

A toddler has been diagnosed with iron-deficiency anemia and is to start iron supplementation. Which of the following is appropriate parental teaching? Select all that apply. 1. "Be sure to give the iron with juice." 2. "The iron can be given with any beverage." 3. "You can give the iron with a straw." 4. "Be sure to bring him back in one month to recheck his hemoglobin.." 5. "Iron causes loose stools."

1. "Be sure to give the iron with juice." 3. "You can give the iron with a straw." 4. "Be sure to bring him back in one month to recheck his hemoglobin.."

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. A child of Mediterranean descent. *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.

Nursing management for the child with juvenile idiopathic arthritis should focus on which of the following? Select all that apply. 1. Pain management 2. Promoting self-care 3. Promoting growth and development 4. Maintaining joint mobility 5. Correcting joint deformities

1. Pain management 2. Promoting self-care 3. Promoting growth and development 4. Maintaining joint mobility

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-specific. 3. Cause a replication of DNA and are cell-specific. 4. Interrupt cell cycle, thereby causing cell death. 5. Prednisone is a natural hormone.

1. Suppress the function of normal lymphocytes in the immune system. 4. Interrupt cell cycle, thereby causing cell death. 5. Prednisone is a natural hormone.

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. The child bruises easily. 2. Excessive menstruation. 3. The child has frequent nosebleeds.

Which of the following is a prognostic factor 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. Child is aged 12 to 15 years.

1. The initial white blood cell count on diagnosis.

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

The parent of a child diagnosed with sickle cell anemia asks that nurse about air Tavel with the child. Which is the best response? 1. "Flying presents a higher risk for infection for a child with sickle cell anemia." 2. "Flying at high altitudes causes decreased oxygen, causing increased sickling." 3. "Flying does not pose any particular risks for the child with sickle cell anemia." 4. "Air travel is not recommended because there are fewer available fluids on flights."

2. "Flying at high altitudes causes decreased oxygen, causing increased sickling."

An 18-month-old male client 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. "What does your child eat every day?" *A diet history is necessary to determine the nutritional status of the child and whether the child is getting sufficient sources of iron. 5. "How much milk does your child drink per day?" *By asking how much milk the child consumes, the nurse can determine whether the child is filling up on milk and then not wanting to take food.

A nurse is caring for a 5-year-old with sickle cell vaso-occlusive crisis. Which of the following 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 fluids. 5. Apply oxygen per nasal cannula to keep oxygen saturations above 94%.

3. Give meperidine (Demerol) 25 mg intravenously every 4 hours as needed for pain. 4. Restrict oral fluids. 5. Apply oxygen per nasal cannula to keep oxygen saturations above 94%.

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. Morphine. 4. Behavioral techniques. 5. Acetaminophen (Tylenol) with codeine.

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. "I will take a rectal temperature daily and report a temperature greater than 101°F (38.3°C) immediately to the health-care provider."

Which of the following measures should the nurse teach the parent of a child with hemophilia to do first 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. Administer factor per the home-care protocol.

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. Offer cool, clear liquids.