NCLEX Q's for 211 Test 1

A client with leukemia has developed neutropenia. The nurse informs the client to avoid which food? 1. White bread 2. Carrot sticks 3. Stewed apples 4. Medium rare steak

2. A low-bacteria diet would be indicated, which excludes raw fruits and vegetables.

A client diagnosed with leukemia is now experiencing neutropenia. Which of the following is a priority assessment by the nurse? 1. Blood pressure 2. Bowel sounds 3. Heart sounds 4. Breath sounds

4. Pneumonia, both viral and fungal, is a common cause of death in clients with neutropenia, so frequent assessment of respiratory rate and breath sounds is required. Although assessing blood pressure, bowel sounds, and heart sounds is important, it won't help detect pneumonia

A student nurse asks the nurse on the hematology unit which type of leukemia has the best prognosis. Which response by the nurse would be the most accurate? 1. Acute lymphoblastic leukemia 2. Acute myelogenous leukemia 3. Basophilic leukemia 4. Eosinophilic leukemia

1. Acute lymphoblastic leukemia, which accounts for more than 80% of all childhood cases, carries the best prognosis. Acute myelogenous leukemia, with several subtypes, accounts for most of the other leukemias affecting children. Basophilic and eosinophilic leukemia are named for the specific cells involved. These are much rarer and carry a poorer prognosis.

Short-term steroid therapy is used in clients with leukemia to promote which of the following? 1. Increased appetite 2. Altered body image 3. Increased platelet production 4. Decreased susceptibility to infection

1. Short-term steroid therapy produces no acute toxicities and results in two beneficial reactions: increased appetite and a sense of well-being. Physical changes, such as "moon face," a result of steroid use, can cause alterations in body image and can be extremely distressing to children. Prednisone (steroid therapy) has no effect on platelet production but may increase susceptibility to infection.

The nurse is assessing a client with leukemia. What assessment findings would indicate that the cancer has invaded the brain? 1. Headache and vomiting 2. Restlessness and tachycardia 3. Hypervigilant and anxious behavior 4. Increased heart rate and decreased blood pressure

1. The usual effect of leukemic infiltration of the brain is increased intracranial pressure. The proliferation of cells interferes with the flow of cerebrospinal fluid in the subarachnoid space and at the base of the brain. The increased fluid pressure causes dilation of the ventricles, which creates symptoms of severe headache, vomiting, irritability, lethargy, increased blood pressure, decreased heart rate, and, eventually, coma. Children with a variety of illnesses are typically hypervigilant and anxious when hospitalized.

A 4-year-old child has recently been diagnosed with acute lymphocytic leukemia (ALL). What information about ALL should the nurse provide when educating the client's parents? Select all that apply. 1. Leukemia is a rare form of childhood cancer. 2. ALL affects all blood-forming organs and systems throughout the body. 3. The child shouldn't brush his teeth because of the increased risk of bleeding. 4. Adverse effects of treatment include sleepiness, alopecia, and stomatitis. 5. There's a 95% chance of remission with treatment. 6. The child shouldn't be disciplined during this difficult time.

2, 4, and 5. In ALL, abnormal white blood cells proliferate, but they don't mature past the blast stage. These blast cells crowd out the healthy white blood cells, red blood cells, and platelets in the bone marrow, leading to bone marrow depression. The blast cells also infiltrate the liver, spleen, kidneys, and lymph tissue. Common adverse effects of chemotherapy and radiation include nausea, vomiting, diarrhea, sleepiness, alopecia, anemia, stomatitis, mucositis, pain, reddened skin, and increased susceptibility to infection. There's a 95% chance of obtaining remission with treatment. Leukemia is the most common form of childhood cancer. The child still needs appropriate discipline and limits. A lack of consistent parenting may lead to negative behaviors and fear.

Which client is most at risk for developing acute lymphocytic leukemia? 1. 25-year-old Black male 2. 4-year-old White female 3. 44-year-old White male 4. 51-year-old Asian female

2. Acute lymphocytic leukemia is most common in young children and in adults age 65 and older. It's also more common in Whites than in Blacks or Asians.

A nurse is administering a blood transfusion to a client with sickle cell anemia. Which assessment findings would indicate that the client is having a transfusion reaction? 1. Diaphoresis and hot flashes 2. Urticaria, flushing, and wheezing 3. Fever, urticaria, and red raised rash 4. Fever, disorientation, and abdominal pain

2. Allergic reactions may occur when the recipient reacts to allergens in the donor's blood; this reaction causes urticaria, flushing, and wheezing. A febrile reaction can occur, causing fever and urticaria, but it isn't accompanied by rash. Diaphoresis, hot flashes, disorientation, and abdominal pain aren't symptoms of a transfusion reaction.

The nurse reviews the treatment plan for a child recently diagnosed with leukemia who is being evaluated for treatment with chemotherapy. Before the initiation of chemotherapy, the nurse anticipates that which of the following tests will be performed? 1. Lumbar puncture 2. Liver function studies 3. Complete blood count (CBC) 4. Peripheral blood smear

2. Liver and kidney function studies are done before initiation of chemotherapy to evaluate the child's ability to metabolize the chemotherapeutic agents. A lumbar puncture is performed to assess for central nervous system infiltration. A CBC is performed to assess for anemia and white blood cell count. A peripheral blood smear is done to assess the maturity and morphology of red blood cells.

Which assessment is important for a child in sickle cell crisis? 1. The child has no bruises. 2. The child has normal skin turgor. 3. The child is ambulatory around the room. 4. The child maintains bladder control.

2. Normal skin turgor indicates the child isn't severely dehydrated. Dehydration may cause sickle cell crisis or worsen a crisis. Bruising isn't associated with sickle cell crisis. Bed rest is preferable during a sickle cell crisis. Bladder control may be lost when oral or I.V. fluid intake is increased during a sickle cell crisis but has no bearing on the primary problem of sickling.

Teaching children with leukemia and their families should include potential adverse effects of treatments. Which of the following is an adverse effect of prednisone? 1. Decreased appetite 2. Increased blood glucose 3. Decreased risk of infection 4. Decreased hair growth

2. Prednisone may cause an increase in blood glucose requiring doses of insulin, especially when other factors are involved. Increased appetite, increased risk of infection, and increased hair growth are also adverse effects of prednisone.

A nurse is developing a teaching plan for parents of a toddler who was just diagnosed with sickle cell anemia. Which statement is important to emphasize in the teaching plan? 1. If they have any more children, those children will also have sickle cell anemia. 2. Knowing how to prevent vaso-occlusive crisis is an important part of the parent's role. 3. The child will have a greater tendency to bleed and should avoid contact sports. 4. Vaso-occlusive crisis will occur eventually, requiring medical care.

2. Prevention is the key to teaching a family of a child with sickle cell anemia. The nurse should emphasize the daily use of prescribed oral antibiotics and avoidance of dehydration, high altitudes, and cold. These interventions can dramatically reduce the incidence of crisis. The disease is autosomal recessive, so each pregnancy has a one in four chance of the child having the disease, a one in four chance of not having the disease, and a two in four chance of carrying the trait. Abnormal bleeding and the need to avoid contact sports are associated with hemophilia.

The nurse is assessing a child with sickle cell anemia. Which bone-related complication would the nurse be alert for during assessment? 1. Arthritis 2. Osteoporosis 3. Osteogenic sarcoma 4. Spontaneous fractures

2. Sickle cell anemia causes hyperplasia and congestion of the bone marrow, resulting in osteoporosis. Arthritis doesn't occur secondary to sickle cell anemia; however, a crisis can cause localized swelling over joints, resulting in arthralgia. Bones do become weakened, but spontaneous fractures don't occur as a result. Osteogenic sarcoma is bone cancer; sickle cell anemia isn't a contributing factor to bone cancer

A pregnant client with sickle cell anemia is at an increased risk for having a sickle cell crisis during pregnancy. The nurse anticipates that aggressive management of a sickle cell crisis would include which treatment? 1. Antihypertensive agents 2. Diuretic agents 3. I.V. fluids 4. Acetaminophen (Tylenol) for pain

3. A sickle cell crisis during pregnancy is usually managed by exchange transfusion, oxygen, and I.V. fluids. Antihypertensive drugs usually aren't necessary. Diuretics wouldn't be used unless fluid overload resulted. The client usually needs a stronger analgesic than acetaminophen to control the pain of a crisis.

The nurse is reviewing laboratory values of a client recently diagnosed with chronic lymphocytic leukemia. The nurse would anticipate the results to include which of the following? 1. Elevated sedimentation rate 2. Uncontrolled proliferation of granulocytes 3. Thrombocytopenia and increased lymphocytes 4. Elevated aspartate aminotransferase and alanine aminotransferase levels

3. Chronic lymphocytic leukemia shows a proliferation of small abnormal mature B lymphocytes and decreased antibody response. Thrombocytopenia also is often present. Uncontrolled proliferation of granulocytes occurs in myelogenous leukemia. Aspartate aminotransferase, alanine aminotransferase, and erythrocyte sedimentation rate values are not affected.

The nurse is caring for a 3-year-old child with acute lymphocytic leukemia and notes the child has a decreased appetite. What is the priority nursing intervention? 1. Provide oral hygiene after eating. 2. Serve snacks as requested. 3. Have the dietician meet with the child and family to provide foods he will eat. 4. Encourage the child to eat all his meal to get adequate nutrition.

3. The dietician should be involved because it is important to provide foods appropriate to children in certain age groups. Involve the child and family in food selection of foods the child will eat. Assess the family's beliefs about food habits. Let the child eat all food that can be tolerated. Take advantage of a hungry period and serve small snacks. Encourage parents to relax pressures placed on eating by stressing the legitimate nature of loss of appetite. The other responses do not help to stimulate the child's appetite.

The nurse is preparing a client diagnosed with leukemia for a spinal tap. The nurse determines that the client understands the reason for the procedure when the client states that the procedure is done: 1. to rule out meningitis. 2. to decrease intracranial pressure (ICP). 3. to aid in classification of the leukemia. 4. to assess for central nervous system (CNS) infiltration

4. A spinal tap is performed to assess for CNS infiltration. A spinal tap can be done to rule out meningitis, but this isn't the indication for the test on a leukemic client. It wouldn't be done to decrease ICP, nor does it aid in the classification of the leukemia. Spinal taps can result in brain stem herniation in cases of increased ICP.

A child is seen in the pediatrician's office for complaints of bone and joint pain. Which other assessment finding may suggest leukemia? 1. Abdominal pain 2. Increased activity level 3. Increased appetite 4. Petechiae

4. The most common signs and symptoms of leukemia are a result of infiltration of the bone marrow. These include fever, pallor, fatigue, anorexia, and petechiae, along with bone and joint pain. Abdominal pain may be caused by areas of inflammation from normal flora within the GI tract or any number of other causes. Increased appetite can occur, but it usually isn't a presenting symptom.

A child with leukemia has been exposed to chickenpox. The mother calls the doctor's office and asks the nurse if the child needs to have anything done. What is the most appropriate response by the nurse? 1. No treatment is indicated. 2. Acyclovir (Zovirax) should be started on exposure. 3. Varicella-zoster immune globulin (VZIG) should be given with evidence of the disease. 4. VZIG should be given within 72 hours of exposure

4. Varicella is a lethal organism to a child with leukemia. VZIG, given within 72 hours, may favorably alter the course of the disease. Giving the vaccine at the onset of symptoms wouldn't likely decrease the severity of the illness. Acyclovir may be given if the child develops the disease but not if the child has just been exposed

A 36-year-old client complains of fatigue, weight loss, and a low-grade fever. He also has pain in his fingers, elbows, and ankles. The nurse identifies these symptoms as indicative of: 1. anemia. 2. leukemia. 3. rheumatic arthritis. 4. systemic lupus erythematosus (SLE).

Fatigue, weight loss, and a low-grade fever are all early signs of many immune system diseases, including anemia, leukemia, and SLE. However, only rheumatic arthritis is associated with pain in the fingers, elbows, wrists, ankles, and knees.

A parent is inquiring about their child who tested positive for sickle cell trait. What is the most appropriate response by the nurse? 1. "Your child has sickle cell anemia." 2. "Your child is a carrier of the disorder but doesn't have sickle cell anemia." 3. "Your child is a carrier of the disease and will pass the disease to any offspring." 4. "Your child doesn't have the disease at present but may show evidence of the disease as he gets older."

. 2. A child with sickle cell trait is only a carrier and may never show any symptoms, except under special hypoxic conditions. A child with sickle cell trait doesn't have the disease and will never test positive for sickle cell anemia. Sickle cell anemia would be transmitted to offspring only as the result of a union between two individuals who are positive for the trait.

Which instruction should be included in a nurse's discharge teaching for the parents of a newborn diagnosed with sickle cell anemia? 1. Stressing the importance of iron supplementation 2. Stressing the importance of monthly vitamin B12 injections 3. Reviewing signs of abdominal pain in infants and demonstrating how to take a temperature 4. Explaining that immunizations are contraindicated

. 3. Acute splenic sequestration is a serious complication of sickle cell anemia. Early detection of splenomegaly by parents is an important aspect of client management. Parents should be able to take the temperature and identify abdominal pain. A temperature of 101.3° F to 102.2° F (38.5° C to 39° C) calls for emergency evaluation, even if the child appears well. Folic acid requirement is increased; therefore, supplementation may be indicated. Vitamin B12 supplementation and iron supplementation aren't necessary. Parents should be encouraged to keep immunizations up to date.

A 14-year-old girl is admitted for sickle cell crisis. Which nursing intervention would be the most important? 1. Gathering information about the child's ability to cope with this condition 2. Monitoring the child's temperature every 2 hours 3. Providing adequate oxygenation, hydrations, and pain management 4. Making sure the family is involved in every step of the child's care

. 3. The most critical need of a client in sickle cell crisis is to provide adequate oxygenation, hydrations, and pain management until the crisis passes. Obtaining a temperature every 2 hours would not be the priority intervention. While assessing the client's ability to cope and involving the family in the child's care are important, they aren't the priority interventions during a sickle cell crisis.

A nurse is caring for a child with sickle cell anemia. The nurse anticipates that which type of transfusion is most likely to be given to the child? 1. Plasma 2. Platelets 3. Whole blood 4. Packed red blood cells (RBCs)

. 4. Packed RBCs are given to children when their hemoglobin is dangerously low. Severe anemia decreases oxygen perfusion and leads to increased sickling of cells. Packed cells are RBCs with plasma removed. If enough whole blood were given to reach the desired hemoglobin level, fluid overload could occur. Thus, the plasma is removed, and packed RBCs are infused. The RBCs are needed to transport oxygen. Platelets are given to children with low platelets, not anemia.

A child with sickle cell anemia is being treated for a crisis. The physician orders morphine sulfate (Duramorph) 2 mg I.V. The concentration of the vial is 10 mg/1 ml of solution. How many milliliters of solution should the nurse administer? Record your answer using one decimal point. ____________________________ milliliters

0.2. The nurse should calculate the volume to be given using this equation: 2 mg/X ml = 10 mg/1 ml; 10X = 2; X = 0.2 ml.

A young, African-American, female client with a history of sickle cell disease is complaining of severe abdominal pain. What is the priority intervention by the nurse? 1. Obtaining a history of the sequence of symptoms 2. Keeping the client nothing by mouth (NPO) 3. Administering I.V. fluids 4. Preparing the client for a computed tomography (CT) scan of the abdomen

1. Although the client may be in a sickle cell crisis and experiencing acute abdominal pain caused by sickling in the mesenteric circulation, it's important to remember that clients with sickle cell disease aren't spared from appendicitis or other intra-abdominal events. The history obtained from the client outlining the sequence of symptoms provides the most important assessment information. Other nursing interventions would include preparing the client for possible surgery by keeping her NPO and for diagnostic studies such as CT scanning. Administering I.V. fluids will help replenish fluid volume.

The nurse is preparing a treatment plan for a child with sickle cell anemia in vaso-occlusive crisis. What is the most important nursing intervention for the nurse to include? 1. Managing pain 2. Providing a cool environment 3. Immobilizing the affected part 4. Restricting fluids

1. Pain management is an important aspect in the care of a client with sickle cell anemia in vaso-occlusive crisis. The goal is to prevent sickling. This can be accomplished by promoting tissue oxygenation, hydration, and rest, which minimize energy expenditure and oxygen utilization. A cool environment can cause vasoconstriction and thus more sickling and pain. Immobilization can promote stasis and increase sickling.

The nurse is being observed by a group of student nurses while assessing a child in vaso-occlusive crisis. A student asks the nurse why she did not palpate the child's abdomen. What is the most appropriate response by the nurse? 1. Risk of splenic rupture 2. Risk of inducing vomiting 3. Increase in abdominal pain 4. Risk of blood cell destruction

1. Palpating a child's abdomen in vaso-occlusive crisis should be avoided because sequestered red blood cells may precipitate splenic rupture. Abdominal pain alone wouldn't be a reason to avoid palpation. Vomiting or blood cell destruction wouldn't occur from palpation of the abdomen.

A client diagnosed with acute lymphocytic leukemia is about to begin chemotherapy. The nurse recognizes that further teaching is necessary when the client makes which statement? 1. "I'll have treatments only once a month." 2. "I'll be getting high doses of chemotherapy." 3. "I won't get sick at this stage of the treatment." 4. "The purpose of these treatments is to induce a remission."

1. The initial phase of chemotherapy is called the induction phase and is designed to put the client into remission by giving high doses of the drugs; however, treatments will be closer together than once each month. Monthly treatments usually occur during the maintenance phase of chemotherapy. The other options indicate that the client understands chemotherapy.

The nurse is providing postoperative care to a client with sickle cell anemia. What is the most important intervention for the nurse to include in the plan of care? 1. Increasing fluids 2. Preparing the child psychologically 3. Discouraging coughing 4. Limiting the use of analgesics

1. The main surgical risk of anesthesia is hypoxia; however, emotional stress, demands of wound healing, and the potential for infection can each increase the sickling phenomenon. Increased fluids are encouraged because keeping the child well hydrated is important for hemodilution to prevent sickling. Preparing the child psychologically to decrease fear will minimize undue emotional stress. Deep coughing is encouraged to promote pulmonary hygiene and prevent respiratory tract infection. Analgesics are used to control wound pain and to prevent abdominal splinting and decreased ventilation.

Which medication would the nurse expect the physician to order most commonly for a client with leukemia as prophylaxis against Pneumocystis carinii pneumonia? 1. Co-trimoxazole (Bactrim) 2. Oral nystatin suspension 3. Prednisone 4. Vincristine

1. The most common cause of death from leukemia is overwhelming infection. P. carinii infection is lethal to a child with leukemia. As prophylaxis against P. carinii pneumonia, continuous low dosages of co-trimoxazole are typically prescribed. Oral nystatin suspension would be indicated for the treatment of thrush. Prednisone isn't an antibiotic and increases susceptibility to infection. Vincristine is an antineoplastic agent.

The parents of a child with sickle cell anemia ask the nurse what would be a priority factor in the prevention of infection for their child. What is the most appropriate response by the nurse? 1. Providing adequate nutrition 2. Avoiding emotional stress 3. Visiting the physician when sick 4. Avoiding strenuous physical exertion

1. The nurse must stress adequate nutrition. Avoiding strenuous physical exertion and emotional stress are important aspects to prevent sickling, but adequate nutrition remains a priority. Frequent medical supervision is imperative to prevention because infection is commonly a predisposing factor toward development of a crisis.

Which finding yields a poor prognosis for a child with leukemia? 1. Presence of a mediastinal mass 2. Late central nervous system (CNS) leukemia 3. Normal white blood cell (WBC) count at diagnosis 4. Disease presents between ages 2 and 10 years

1. The presence of a mediastinal mass indicates a poor prognosis for children with leukemia. The prognosis is poorer if age at onset is younger than 2 years or older than 10 years. A WBC count of 100,000/ml or higher and early CNS leukemia also indicate a poor prognosis for a child with leukemia.

A child with sickle cell anemia is being discharged after treatment for a crisis. Which instructions for avoiding future crises should the nurse provide to the client and his family? Select all that apply. 1. Avoid foods high in folic acid. 2. Drink plenty of fluids. 3. Use cold packs to relieve joint pain. 4. Report a sore throat to an adult. 5. Restrict activity to quiet board games. 6. Wash hands before meals and after playing.

2, 4, and 6. Fluids should be encouraged to prevent stasis in the bloodstream, which can lead to sickling. Sore throats, and any other cold symptoms, should be reported because they may indicate the presence of an infection, which can precipitate a crisis (red blood cells sickle and obstruct blood flow to tissues). Children with sickle cell anemia should learn appropriate measures to prevent infection, such as proper hand-washing techniques and good nutrition practices. Folic acid intake should be encouraged to help support new cell growth because new cells replace fragile, sickled cells. Warm packs should be applied to provide comfort and relieve pain; cold packs cause vasoconstriction. The child should maintain an active, normal life. When the child experiences a pain crisis, he limits his own activity according to his pain level.

Which intervention is indicated for a child in sickle cell vaso-occlusive crisis? 1. Immobilizing the affected part 2. Applying warm packs to the affected part 3. Applying cool packs to the affected part 4. Performing active range-of-motion (ROM) exercises to the affected part

2. Applying warm packs promotes vasodilation and perfusion and provides pain relief and comfort. Immobilization leads to stasis, which promotes sickling. Cool packs are contraindicated because they cause vasoconstriction and may precipitate red blood cell sickling. A child in vasoocclusive crisis experiences acute pain and limits movement of the affected part. After the acute crisis passes, the child should be encouraged to ambulate. Active ROM exercises increase pain in the affected part

The parents of a child diagnosed with leukemia have stated that they'll give aspirin to their child for pain relief. What is the most appropriate response by the nurse? 1. "It's contraindicated because it decreases platelet production." 2. "It's contraindicated because it promotes bleeding tendencies." 3. "It's not a strong enough analgesic." 4. "It decreases the effects of methotrexate (Trexall)."

2. Aspirin would be contraindicated because it promotes bleeding. Aspirin use has also been associated with Reye's syndrome in children. For home use, acetaminophen (Tylenol) is recommended for mild to moderate pain. Aspirin enhances the effects of methotrexate and has no effect on platelet production. Nonopioid analgesia has been effective for mild to moderate pain in clients with leukemia.

Which assessment finding would indicate vaso-occlusive crisis in a child with sickle cell anemia? 1. Painful urination 2. Pain with ambulation 3. Complaints of throat pain 4. Fever with associated rash

2. Bone pain is one of the major symptoms of vaso-occlusive crisis in clients with sickle cell anemia. Hand-foot syndrome, characterized by edematous painful extremities, is usually exhibited in the refusal of the child to bear weight and ambulate. Painful urination doesn't occur, but sickle cell anemia can cause kidney abnormalities. Throat pain isn't a symptom of vasoocclusive crisis. Fever commonly accompanies vaso-occlusive crisis but isn't associated with rash.

A 4-year-old child is diagnosed as having acute lymphocytic leukemia. His white blood cell (WBC) count, especially the neutrophil count, is low. What is the most important intervention the nurse should teach the parents? 1. Protect the child from falls because of his increased risk of bleeding. 2. Protect the child from infections because his resistance to infection is decreased. 3. Provide rest periods because the oxygen-carrying capacity of the child's blood is diminished. 4. Treat constipation, which frequently accompanies a decrease in WBC.

2. One of the complications of both acute lymphocytic leukemia and its treatment is a decreased WBC count, especially a decreased absolute 1514 neutrophil count. Because neutrophils are the body's first line of defense against infection, the child must be protected from infection. Bleeding is a risk factor if platelets or other coagulation factors are decreased. A decreased hemoglobin level, hematocrit, or both would reduce the oxygen-carrying capacity of the child's blood. Constipation isn't related to the WBC count.

Which complications are the three main consequences of leukemia? 1. Bone deformities, spherocytosis, and infection 2. Anemia, infection, and bleeding tendencies 3. Lymphocytopoiesis, growth delays, and hirsutism 4. Polycythemia, decreased clotting time, and infection

2. The three main consequences of leukemia are anemia, caused by decreased erythrocyte production; infection secondary to neutropenia; and bleeding tendencies, from decreased platelet production. Bone deformities don't occur with leukemia, although bones may become painful because of the proliferation of cells in the bone marrow. Spherocytosis refers to erythrocytes taking on a spheroid shape and isn't a feature in leukemia. Lymphocytopoiesis is production of lymphocytes with leukemia. Mature cells aren't produced in adequate numbers. Hirsutism and growth delay can be a result of large doses of steroids but aren't common in leukemia. Anemia, not polycythemia, occurs. Clotting times would be prolonged.

A client with thrombocytopenia, secondary to leukemia, develops epistaxis. The nurse would instruct the client to: 1. lie supine with his neck extended. 2. sit upright, leaning slightly forward. 3. blow his nose and then put lateral pressure on it. 4. hold his nose while bending forward at the waist.

2. The upright position, leaning slightly forward, avoids increasing the vascular pressure in the nose and helps the client avoid aspirating blood. Lying supine won't prevent aspiration of blood. Nose blowing can dislodge any clotting that has occurred. Bending at the waist increases vascular pressure and promotes bleeding rather than stopping it.

A mother brings her 12-month-old, African-American female child to the emergency department. The mother states the child's eyes are yellow. The nurse assesses the child and notes tachycardia and shortness of breath. The nurse anticipates a diagnosis of: 1. thalassemia. 2. hemophilia A 3. sickle cell anemia. 4. leukemia.

3. Clinical signs of sickle cell anemia may not appear until the child is 12 months old after fetal hemoglobin has been replaced.

Before starting treatment for leukemia, a client receives I.V. fluids and allopurinol (Zyloprim). The goal of these interventions is to reduce the risk of: 1. disseminated intravascular coagulation (DIC). 2. pancytopenia. 3. tumor lysis syndrome. 4. mucositis

3. During chemotherapy for leukemia, tumor lysis syndrome may occur as cell destruction releases intracellular components, resulting in hyperuricemia. Large fluid quantities and allopurinol therapy help reduce the amount of uric acid as a result of tumor lysis syndrome but don't stop the cell lysis. Although DIC, pancytopenia, and mucositis are possible chemotherapy complications, they're not treated with I.V. fluids and allopurinol.

A nurse is teaching the parents of a child with acute lymphoblastic leukemia. The parents ask for information about what helps determine longterm survival. The nurse discusses which of the following as the three most important prognostic factors? 1. Histologic type of disease, initial platelet count, and type of treatment 2. Type of treatment, stage at diagnosis, and child's age at diagnosis 3. Histologic type of disease, initial white blood cell (WBC) count, and client's age at diagnosis 4. Progression of illness, WBC count at time of diagnosis, and client's age at diagnosis

3. Histologic type of leukemia is the factor whose prognostic value is considered to be of greatest significance in determining long-range outcome. Children with a normal or low WBC count appear to have a much better prognosis than those with a high WBC count. Children diagnosed between ages 2 and 10 years have consistently demonstrated a better prognosis than those diagnosed before age 2 or after age 10 years.

What is a nurse's role with the parents of a child who has been diagnosed with sickle cell anemia? 1. Encouraging selective birth methods or abortion 2. Referring only sickle cell-positive parents for counseling 3. Rendering support to parents of newly diagnosed children 4. Reinforcing the idea that transmission is unlikely in subsequent pregnancies

3. The nurse can be instrumental in providing genetic counseling. She can give parents correct information about the disease and render support to parents of newly diagnosed children. Alternative birth methods are discussed, but parents make their own decisions. All heterozygous, or trait-positive, parents should be referred for genetic counseling. The risk of transmission in subsequent pregnancies remains the same

The nurse has just admitted a client with sickle cell crisis. What is the priority intervention by the nurse? 1. Giving blood transfusions 2. Giving antibiotics 3. Increasing fluid intake and giving analgesics 4. Preparing the client for a splenectomy

3. The primary therapy for sickle cell crisis is to increase fluid intake according to age and to give analgesics. Blood transfusions are only given conservatively to avoid iron overload. Antibiotics are given to clients with fever. Routine splenectomy isn't recommended. Splenectomy in clients with sickle cell anemia is controversial.

The nurse is reviewing the interventions listed in the plan of care for a child in vaso-occlusive crisis. What is the most important intervention for the nurse to implement? 1. Administering analgesics 2. Monitoring fluid restrictions 3. Encouraging activity as tolerated 4. Administering oxygen as prescribed

4. Administering oxygen is the most effective way to maximize tissue perfusion. Short-term oxygen therapy helps to prevent hypoxia, which leads to metabolic acidosis, causing sickling. Long-term oxygen therapy will depress erythropoiesis. Analgesics are used to control pain. Hydration is essential to promote hemodilution and maintain electrolyte balance. Bed rest should be promoted to reduce oxygen utilization.

A client with sickle cell disease is discussing his therapeutic regimen Which statement by the client indicates further teaching is needed? 1. "I should avoid vacationing or traveling in areas of high altitude." 2. "Cigarette smoking can cause a sickle cell crisis." 3. "I should drink 4 to 6 Lof fluid each day." 4. "I should take one baby aspirin daily to help prevent sickle cell crisis."

4. Aspirin inhibits platelet aggregation and won't help prevent sickle cell crisis. Hydroxyurea is prescribed for some people to help prevent sickle cell crisis. High altitude increases oxygen demand and therefore can also precipitate a crisis. Tobacco, alcohol, and dehydration can precipitate a sickle cell crisis and should be avoided.

A nurse is speaking to the mother of a child with leukemia who wants to know why her child is so susceptible to infection if he has too many white blood cells (WBCs). Which response by the nurse would be most accurate? 1. This is an adverse effect of the medication he has to take. 2. He hasn't been able to eat a proper diet since he's been sick. 3. Leukemia is a problem of tumors in the internal organs that prevent his ability to fight infection. 4. Leukemia causes production of too many immature WBCs, which can't fight infection very well.

4. Leukemia is an unrestricted proliferation of immature WBCs, which don't function properly and are a poor defense against infection. Diet contributes to overall health but doesn't cause the overproduction of WBCs. There are no solid tumors in the internal organs in leukemia. Medications such as chemotherapy can diminish the immune system's effectiveness; however, they don't cause the overproduction of immature WBCs and the poor resistance to infection that the mother asked about

A nurse is speaking to the mother of a child with leukemia who wants to know why her child is so susceptible to infection if he has too many white blood cells (WBCs). Which response by the nurse would be most accurate? 1. This is an adverse effect of the medication he has to take. 2. He hasn't been able to eat a proper diet since he's been sick. 3. Leukemia is a problem of tumors in the internal organs that prevent his ability to fight infection. 4. Leukemia causes production of too many immature WBCs, which can't fight infection very well.

4. Leukemia is an unrestricted proliferation of immature WBCs, which don't function properly and are a poor defense against infection. Diet contributes to overall health but doesn't cause the overproduction of WBCs. There are no solid tumors in the internal organs in leukemia. Medications such as chemotherapy can diminish the immune system's effectiveness; however, they don't cause the overproduction of immature WBCs and the poor resistance to infection that the mother asked about.

The nurse is assessing a client in the emergency department suspected of being in vaso-occlusive crisis. Which assessment findings would indicate that 1484 the client is having a vaso-occlusive crisis? 1. Hypotension and thready pulse 2. Pallor and poor capillary refill 3. Anemia, jaundice, and reticulocytosis 4. Acute leg pain and hand-foot syndrome

4. Vaso-occlusive crises are the result of sickled cells obstructing the blood vessels. The major symptoms are fever, acute pain from visceral hypoxia, hand-foot syndrome, and arthralgia. A precipitous drop in blood volume is indicative of a splenic sequestration crisis and is exhibited by hypotension and a thready pulse. Aplastic crisis exhibits pallor and poor capillary refill and may result in symptoms of shock. Hyperhemolytic crisis is characterized by anemia, jaundice, and reticulocytosis and may also produce symptoms of shock.