hematology/oncology

Which of the following is correct regarding prognostic features for determining survival for a child newly diagnosed with ALL 1 the initial WBC count on diagnosis 2 the race of the child 3 the amount of time needed to initiate treatment 4 child age 12 to 15 years old

1 the initial WBC count on diagnosis

a nurse is doing discharge education with a parent who had a child with data policy Mia the nursing forms apparent 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 & iron overload

4

A nurse is caring for a child with a diagnosis of a LL who is receiving chemotherapy the nurse notes that the child's platelet count is 20,000 based on this lab finding what information should the nurse provide to the child and parents 1 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 four hours 4 all visitors should be discouraged from coming to see the family

1 A soft toothbrush should be used for mouth care

Lab tests are prescribed for the client who has a smooth and reddened tongue and ulcers at the corners of the mouth which result would the nurse find if the client has iron deficiency anemia 1 low hemoglobin and hematocrit 2 elevated RBCS 3 prolong prothrombin time 4 elevated WCBs

1 a smooth red tongue ulcers at the corners of the mouth and a low hemoglobin are signs of iron deficiency anemia

The nurse is caring for a child with leukaemia the nurse should be aware that children being treated for leukaemia 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

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

The new nurse requests information about CLL which statement should an experienced nurse include select all that apply 1 CLL is a malignancy of activated B lymphocytes 2 CLL is the most common malignancy of older adults 3 CLL is unresponsive to chemotherapy treatment 4 clients are monitored in its early stages an are often not treated 5 in CLL immature lymphocytes accumulate in the bone marrow 6 clients with CLL often have no symptoms of the disorder

1, 2, 4, 6 CLL derives from a malignant clone of B lymphocytes 2/3 of all persons with CLL are older than 60 years at diagnosis science would CLL are monitored and treatment is initiated when symptoms are severe or the disease progresses to later stages because many persons are asymptomatic it is often diagnosed during a routine physical or during treatment for another condition

What did the following factors need to be included to 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 parents 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

A child has completed treatment for leukemia and comes to the clinic for a checkup with the parents the parents expressed 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 a higher risk for a second cancer

A5 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 knows that the diagnosis will be confirmed by which of the following 1 lumbar puncture 2 WBC count 3 bone mirror aspirate 4 bone scan

3 bone marrow aspirate

the nurse is teaching the client who is a strict vegetarian how to decrease the risk of developing megaloblastic anemia which information should the nurse provide 1 undergo an annual Schilling test 2 increase intake of foods high in iron 3 supplement the diet with vitamin B12 4 have a hemoglobin level drawn monthly

3 the client consuming a vegetarian diet can prevent megaloblastic anemia from her vitamin B12 deficiency with oral vitamin supplements or fortified soy milk

Which test provides a definitive diagnosis of aplastic anemia 1 complete blood count with differential 2 serum IgG levels 3 bone marrow aspiration 4 basic metabolic panel

3 bone marrow aspiration

A nurse is caring for a 5 year old with sickle cell vaso occlusive crisis which of the following order should the nurse question select all that apply 1 position the child for comfort 2 apply hot packs to painful areas 3 give meperidine 25 milligrams Ivy every four hours as needed for pain 4 restrict oral fluids 5 apply oxygen per nasal cannula to keep oxygen sats above 94%

3, 4, 5

The nurse observes the NA preparing a food tray for the four year old who recently underwent a bone marrow transplant which food item should the nurse remove from the child's tray 1 orange juice 2 Apple slices 3 slice of bread 4 soft fried egg

4 a soft egg is under cooked it should be well cooked and firm the eggs should be removed from the tray because the child has a weakened immune system and the egg may harbor microorganisms

The nurse is caring for the two year old with iron deficiency anemia what should the nurse recommend select all that apply 1 limit the toddler's milk intake to 24 ounces per day 2 limit the toddler's juice intake to four to six oz per day 3 offer iron rich foods such as beef lentils broccoli and raisins 4 even is vegan, avoid feeding the toddler a vegan diet 5 parental feeding of the toddler to ensure an adequate intake

1, 2, 3 Milk should be limited to 24 ounces per day to maintain an appetite for iron rich cereals meats fruits and vegetables juice should be limited 2426 oz per day for children ages one to five years beef lentilles broccoli and raisins are some of the iron rich foods a toddler can consume a vegan diet if the diet is well planned to include iron rich foods

The pediatric client receiving treatment with aggressive combination chemo has stomatitis which intervention should the nurse include in the client's plan of care select all that apply 1 perform oral care with soft sponge every two to four hours 2 use alcohol based mouthwash diluted with water to lessen irritation 3 swab the child's mouth with viscous lidocaine before performing oral care 4 cleanse a child's guns using a piece of gauze soaked in Saline or plain water 5 massage the back of the child's hands between the thumb and index finger with an ice cube for five to 7 minutes

1, 4, 5 Stop toothbrushes or sponges are used to reduce trauma to the oral mucosa frequent oral care rids mucosal surfaces of debris which is an excellent medium for bacterial and fungal growth a moistened gauze is appropriate for cleansing the gums to remove debris that could be a medium for bacterial and fungal growth massage in the area of the backs of both hands between the thumbs and index fingers is a nice with an ice cube for five to 7 minutes until numb is a reflexology strategy to reduce oral pain

The nurse discusses their self care guidelines to minimize the side effects of radiation on the skin which action to reduce radiation skin reactions should the nurse explain to the client select all that apply 1 worse loose fitting soft clothing over the treated skin 2 use a straight edged razor to shave hair in the treated area 3 swim only in swimming pools to avoid stagnant water 4 use only skin care products suggested by the radiation staff 5 apply skin parts immediately after radiation treatment 6 Mars treated area gently with Luke warm water and mild soap

1, 4, 6

A nurse instructs a parent of a child would 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

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 base for the Flowers 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 Flowers 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 Flowers in it and bring it to the room 4 get rid of the Flowers immediately you could harm the child

2 the Flowers from your garden are beautiful but should not be placed in the room at this time

An 18 month old male is brought to the clinic by his mother his weight is in the 50th percentile his weight is in the 80% percentile the child is pale the physical exam is normal but his hct 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 is your child eat everyday 4 has a child been given any new medications 5 how much milk is your child drink per day

3, 5

The nurses caring for a child with sickle cell disease the nurse is aware that which of the following problems 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

A nurse is caring for a child who has oral muco cystitis Which of the following actions should the nurse take SATA A swab the mucosa with lemon glycerine swabs B apply viscous lidocaine C offer soft foods D use a soft disposable toothbrush for oral care E encourage gargling with a warm sailing outwash

C,D,E

The hospital child is neutropenic due to chemo treatment which instruction should the nurse plan to include when preparing the parents to take the child home select all that apply 1 ask those who were recently vaccinated not to come for a visit yet 2 keep the child's immediate surroundings free of plants and Flowers 3 provide items such as goldfish sanitized toys or books for playtime 4 arrange for the child to sleep alone preferably in his or her own room 5 take your child's temperature respiratory rate and pulled four times daily

1, 2, 4

Which of the following factors needs 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 parents should make sure the child sleeps in an air-conditioned room 3 emotional stress should be avoided 4 it is important to keep child one hydrated 5 it is important to make sure the child gets adequate nutrition

1, 3, 4, 5

Which is the following can be manifestations of leukaemia in a child select all that apply 1 leg pain 2 fever 3 excessive weight game 4 bruising 5 enlarged lymph nodes

1,2,4,5

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 1. a child of Mediterranean descent 2. a child of Mexican descent 3. a child his mother has chronic anemia 4. a child who has a low intake of iron

1. A child of Mediterranean descent

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 in if the temperature is greater than 101 degrees Fahrenheit 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 immunity globulin vaccine 4 your child will need to be isolated for the next two weeks 5 your child may develop Chickenpox lesions after 14 to 21 days after exposure

2, 3 the child has had two varicella immunizations as an infant but is no longer immune after chemotherapy you need to bring the child to the clinic for varicella Amy new globen vaccine

The nurse is assessing a child newly diagnosed with ALL which assessment findings should the nurse expect based on the child's diagnosis select all that apply 1 alopecia 2 petechiae 3 anorexia 4 insomnia 5bleeding guns 6 pallor

2, 3, 5, 6

A NURSE is caring for a 5 year old with sickle cell vaso occlusive crisis which 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 IV every 4 hours as needed for pain 4 restrict oral fluids 5 apply oxygen NC to keep oxygen saturations above 94%

3, 4, 5 Demerol should be avoided because of the risk of demerol induce seizures

An 18 mo 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 exam is normal, but his hct level is 20%. Which of the following questions should assist the nurse in making a diagnosis. SATA 1. How many bowel mvnts a day does your child have 2. How much did your baby wt at birth 3. What does your child eat everyday 4. Has the child been given any new meds 5. How much milk does your child drink per day

3, 5 3: determines nutritional status 5: the nurse can determine whether the child is filling up on milk and then not wanting to take food

Complications in chemo are increased uric acid what medication is used to decrease uric acid production and protect the kidneys

Allopurinol

The nurse reads in the HCP history and physical note that the hospitalized child has a pica eating disorder which conclusion by the nurse is correct select all the apply 1 the child consistently eats nonfood substances such as dirt crayons and paper 2 the child regurgitates, chews then re swallows previously ingested food 3 a primary safety concern for the child is a possibility of accidental poisoning 4 the child's greatest risk aspiration should be monitored for at all times 5 complications of the disorder can include malabsorption and people impaction 6 usually children with pica disorders are intellectually bright and precocious

1, 3, 5

Osteosarcoma usually occurs in the long bones often in the femur treatment includes

Amputation

What baseline functioning tests are checked before chemotherapy

Liver and kidney function studies

Ewing's sarcoma often occurs in the shafts of long bones treatment includes

Surgical biopsy radiation chemotherapy not amputation Or limb salvage

the nurse assesses a client with hemolytic anemia who has weakness fatigue malaise and skin and mucous membrane pallor which findings should the nurse also associate with hemolytic anemia 1 sclareol jaundice 2 a smooth red tongue 3 a craving for ice to chew 4 a poor intake of fresh vegetables

1 Jaundice occurs in hemolytic anemia from the short lifespan of the RBC and the breakdown of hemoglobin

The new nurse is telling the experienced nurse about treatments that the HCP discussed with the parents of the child who has thalassemia major which statement by the new nurse should be experienced nurse question 1 plasma pheresis will help remove the toxins that are destroying the RBCS 2 blood transfusions will need to be administered about every two to four weeks 3 a splenectomy may be necessary to reduce the child's abdominal comfort 4 bone marrow stem cell transplant might cure this child's thalassemia

1 Thalassemia major occurs from a deficiency in the synthesis of the beta chain of the hemoglobin this result is defective hemoglobin obstruction of RBCS an anemia plasma pheresis selective removal of the plasma would be ineffective in treating thalassemia because the cells are not being destroyed by toxins in the plasma

A child diagnosed with leukemia is receiving Allopurinol (zyloprim) as part of the treatment plan the parent asked 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 chemo 4 helps decrease pain in the bone marrow

1 helps reduce the uric acid level caused by cell destruction

The nurse assesses the client diagnosed with AML which finding should be the nurses priority for implementing interventions 1 pain from mucositis an oral tissue injury 2 weakness and fatigue with slight activity 3 temp 99 pulse 100 respiratory 22 BP 132 / 64 4 ecchymoses and petechiae noted on arms done

1 pain is priority

The nurse is caring for a child being treated for ALL lab results indicate that the child has a WBC count of 5000 with five percent polys and 3% bands which of the following analysis is most appropriate 1 the absolute neutrophil count is 400 and the child is neutropenic 2 the absolute neutrophil count is 800 and the child is neutropenic 3 the absolute neutrophil count is 4000 and the child is not neutropenic 4 the absolute pro count is 5800 and the child is not neutropenic

1 the absolute neutrophil count is 400 and the child is neutropenic

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

Which of the following measures should the nurse implement to help with the nausea in vomiting caused by chemotherapy select all that apply 1 give an anti medic 30 minutes prior to the start of therapy 2 Continue the anti medic as ordered until 24 hours after the chemo 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 anti medic

1, 2, 3

the adolescent is scheduled to have total body irritation in preparation for a bone marrow transplant the nurse has completed teaching about care following irritation which statement by the adolescent indicates correct understanding of the information select all that apply 1 I should use a soft toothbrush to prevent bleeding and avoid getting myself injured 2 I will ensure that the raw fruits and vegetables I eat are well washed and not spoiled 3 to relieve my dry mouth I can step on losinj is or popsicles or drink cold liquids 4 I will need to take my anti emetic around the Clock to help prevent nausea and vomiting 5 once the irrigation is completed I will no longer need to be in protective isolation

1, 2, 3, 4 irritation results in bone marrow suppression and pancytopenia bleeding precautions are necessary recent research has found that raw fruits and vegetables do not increase the risk of infection these are allowable as long as they are well washed and not spoiled vegetable sprouts such as alfalfa should not be eaten xerostomia is a side effect that can be combated with lozenges, cold liquid's or oral hygiene antiemetics are given around the Clock to control nausea

The nurses 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 the splenectom 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

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 decrease the risk of bleeding 2 eliminates excess iron 3 prevents further cycling of the red blood cells 4 provides an iron supplement 5 hydration is necessary for the process to be effective

2 eliminates excess iron

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

The nurse is taking care of a child with sickle cell disease. The nurse is aware that which of the following problems are associated with SCD. SATA 1. polycythemia 2. hemarthrosis 3. Aplastic crisis 4. Thrombocytopenia 5. Vaso-occlusive crisis

3: aplastic crisis, 5: Vaso-occlusive crisis

The nurse is developing the plan of care for the child hospitalized and sickle cell crisis which nursing problem is priority 1 risk for deficient fluid volume related to inadequate fluid intake due to pain 2 chronic pain related to chronic physical disability an clustering of sickled cells 3 risk for infection related to ineffectively functioning spleen and poor health 4 ineffective tissue profusion related to pulmonary infiltrates of abnormal blood cells

4 Acute chest syndrome is a common cause of hospitalization for sickle cell disease an effective tissue perfusion is priority because it can be life threatening

Which intervention should be implemented after bone mirror aspiration 1 ask the child to remain in a supine position 2 place the child in an upright position for four hours 3 keep the child nothing by mouth for six hours 4 administer analgesics as needed for pain

4 administer the analgesics as needed for pain

The client had basil cell carcinoma lesions excised the day before at an outpatient clinic the client telephones in nurse expressing concern that the wounds are draining watery pale pink fluid and that the small dressing is leaking which action should the nurse recommend 1 apply ice to the area 2 contact the surgeon 3 take pain medication 4 change the dressings

4 change the dressings

The nurse teaches a client with iron deficiency anemia to eat foods high in iron and foods that contain vitamin C at the same meal to increase iron absorption the nurse evaluates that teaching is effective when the client selects the meal that includes which foods 1 yogurt and oranges 2 shrimp and potatoes 3 lean beef steak and broccoli 4 chicken and leafy green vegetables

4 chicken and leafy green vegetables

Prednisone is given to a child who is 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

the nurse is caring for the malnutrition adolescent consuming a vegan diet the nurse should assess for which signs of vitamin deficiency in the client 1 Vitamin A 2 vitamin C 3 vitamin K 4 vitamin B12

4 vegans abstain from eating animal products which provide vitamin B12

A child is doing discharge education with a parent who has a child with beta thalassemia the nurse informs a 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 in iron overload

4. Chronic hypoxia an iron overload

A nurse is assessing a child who has leukaemia which of the following are early manifestations of leukaemia select all that apply A haematuria B anorexia C petechiae D ulceration of the mouth E unsteady gait

B,C,D anorexia, petechiae, unsteady gait are early manifestations of leukaemia