NUR105 Module 4

The parents of a 6-year-old child with idiopathic thrombocytopenic purpura (ITP) ask the nurse, "What causes this disease?" Which response by the nurse would be most appropriate?

"ITP is primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason."

The nurse is caring for a child admitted to the hospital for an open fracture of the femur following a motor vehicle accident. The nurse notes the following lab values: white blood cells 10,000/mm3, hemoglobin 7.9 g/dl (79 g/L), hematocrit 28%, platelets 151,000/mm3. Which nursing action is priority?

Transfuse 1 unit of packed red blood cells.

A school nurse is teaching a group of parents about signs and symptoms of cancer in children. Which symptom is an early sign of a brain tumor?

headache, vision changes, and vomiting

A nurse is teaching the parents of a child with sickle cell disease about factors that predispose the child to a sickle cell crisis. The nurse determines that the teaching was successful when the parents identify what as a factor?

infection

A nurse is caring for a child with Hodgkin disease who is in the induction phase of a chemotherapy regimen. The nurse explains to the parents that the goal of this phase is to:

kill enough cancerous cells to induce remission.

To prevent further sickle cell crisis, the nurse would advise the parents of a child with sickle cell anemia to:

notify a health care provider if the child develops an upper respiratory infection.

The nurse in the emergency department is caring for a 10-year-old female child with sickle cell crisis. Child rates pain 10 on a scale of 0 to 10. Vital signs: 99.8°F (37.6°C); heart rate, 122 beats/min; blood pressure, 92/50 mm Hg; respiratory rate, 26 breaths/min; oxygen saturation, 92% on room air.

- Administer oxygen to maintain oxygen saturation greater than 95%. - Start normal saline continuous intravenous (IV) infusion at 200 ml/hr. - Administer 100 mcg/kg morphine IV for pain prn q4 hours.

The nurse is caring for a school-age child recovering from an allogeneic stem cell transplant. What nursing action best ensures the child does not develop an infection after the transplant? Select all that apply.

- Restrict all visits from other children. - Provide sterilized age-appropriate play materials.

Which nursing interventions would be appropriate for the plan of care designed for a child diagnosed with hemophilia who is experiencing an episode of active bleeding? Select all that apply.

- administering acetaminophen as prescribed for pain - scheduling physical therapy for 48 hours after bleeding stops - applying splints to extremities - encouraging self performance of active range-of-motion exercises

Parents ask why their child just diagnosed with leukemia needs a "spinal tap." Which is the best response by the nurse?

"Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system."

The health care provider has just informed the parents of a 3-year-old that their child has leukemia. The mother begins crying and tells the nurse she does not want her baby to die. What is the nurse's best response?

"I know this is scary, but leukemia has a high cure rate in children these days."

The nurse is caring for a toddler taking ferrous sulfate for severe iron-deficiency anemia. Which report by the parent is most concerning?

"I mix ferrous sulfate with milk in a bottle."

A nurse is providing dietary interventions for a 5-year-old with an iron deficiency. Which response indicates a need for further teaching?

"Red meat is a good option; he loves the hamburgers from the drive-thru."

A couple is expecting a child. The fetus undergoes genetic testing and the couple discover the fetus has sickle cell disease. The couple ask the nurse how most commonly happens. Which statement is accurate for the nurse to provide?

"Sickle cell disease is passed to a fetus when both parents have the gene."

The nurse caring for a 14-year-old scheduled for magnetic resonance imaging (MRI) explains to a family how the test works. Which response accurately describes this test?

"The MRI uses radio waves and magnets to produce a computerized image of the body."

The parents of a child diagnosed with cerebral astrocytoma ask the nurse about their child's prognosis. Which response by the nurse would be most appropriate?

"The prognosis is favorable with complete surgical resection and the child usually experiences minimal neurologic deficits post-operatively."

A child is to receive an oral corticosteroid as part of the treatment regimen for leukemia. After teaching the child and family about this drug, the nurse determines the need for additional teaching when they state:

"We should administer the drug on an empty stomach."

A 9-year-old child with leukemia is scheduled to undergo an allogeneic hematopoietic stem cell transplant. When teaching the child and parents, what information would the nurse include?

"We'll need to have a match to a donor."

The nurse is caring for a child diagnosed with thalassemia. What laboratory value(s) would the nurse expect to monitor for this child? Select all that apply.

- Hemoglobin - Iron level

The nurse is reviewing the results of a clotting study for a healthy 6-year-old. What would the nurse document as a normal prothrombin finding?

11.0 to 13.0 seconds

The nurse is caring for a pediatric client who is scheduled for the surgical removal of a Wilms tumor. Which action is contraindicated in the client's care?

Abdominal palpation

A client with cancer is diagnosed with typhlitis. Which emergency intervention would the nurse perform?

Administer broad-spectrum antibiotics intravenously.

The toddler with a cancer diagnosis is seen for a well-child checkup. Which health maintenance activity will the nurse exclude?

Administering the measles, mumps, rubella (MMR) vaccine

The nurse is preparing to send a child with cancer for a radiation treatment. Which medication should the nurse provide to premedicate the child for this procedure?

Antiemetic

The nurse is providing preoperative care for a 7-year-old boy with a brain tumor, as well as his parents. Which intervention is a priority?

Assessing the child's level of consciousness.

A group of nursing students are studying information about childhood cancers in preparation for a class examination. They are reviewing how childhood cancers differ from adult cancers. The group demonstrates understanding of the information when they identify what location as an unlikely site for childhood cancer?

Bladder

The child is prescribed liquid ferrous sulfate. The nurse should encourage the child to take which action immediately after each dose to best eliminate possible side effects?

Brush his or her teeth

The nurse is preparing a discharge teaching plan for the parents of an 8-year-old girl with leukemia. Which instruction would be the priority?

Calling the doctor if the child gets a sore throat

The nurse is assessing a 10-year-old girl with acute lymphoblastic leukemia. What information would lead the nurse to suspect that the cancer has infiltrated the central nervous system?

Child reports facial palsy and vision problems

The nurse is caring for a 10-year-old girl with iron toxicity. What would the nurse expect the physician to order?

Deferasirox

The nurse is caring for a child who had a stem cell transplant and is being monitored for engraftment. Which nursing action is priority?

Ensure neutropenic precautions are in place.

The pediatric nurse reviews the radiographs of a child and observes that there are lesions on the bone. The nurse interprets this finding as suggesting which condition?

Ewing sarcoma

The nurse explains to the teenager that which alterations may occur when steroids are added to the cancer therapy regimen?

Facial changes

A toddler who is beginning to walk has fallen and hit his head on the corner of a low table. The caregiver has been unable to stop the bleeding and brings the child to the pediatric clinic. The nurse is gathering data during the admission process and notes several bruises and swollen joints. A diagnosis of hemophilia is confirmed. This child most likely has a deficiency of which blood factor?

Factor VIII

The parent contacts the health care provider because their preschool-aged child has a temperature of 101.5°F (38.6°C). The child received outpatient chemotherapy 1 week ago. Which is the most appropriate response by the nurse?

Have the parent bring the child to the pediatric oncology clinic as soon as possible.

A nurse is preparing a 7-year-old girl for bone marrow aspiration. Which site should she prepare?

Iliac crest

Which nursing diagnosis would be most appropriate for a child with idiopathic thrombocytopenic purpura?

Ineffective tissue perfusion related to poor platelet formation

The nurse is planning care for a child with idiopathic thrombocytopenic purpura. Which client education should be included?

Not to pick or irritate the nose

The nurse is developing a plan of care for a child who is to have a transfusion. Which would the nurse expect to administer because it is the most common form of transfusion?

Packed red blood cells

Which nursing diagnosis should the nurse identify as being the most appropriate for a child with idiopathic thrombocytopenic purpura?

Risk for bleeding related to insufficient platelet formation

A child with iron-deficiency anemia is prescribed ferrous fumarate, 3 mg/kg/day in 2 divided doses. The nurse interprets this order as indicating what?

The child has mild to moderate iron deficiency.

After teaching a group of nursing students about chemotherapy agents used in treatment cancer, the instructor determines that the teaching was successful when the students identify cisplatin as which type of drug?

alkylating agent

What would the nurse expect to be ordered for a child with acute lymphoblastic leukemia who develops tumor lysis syndrome?

allopurinol

The nurse is caring for a child admitted with suspected leukemia. The nurse has taken the child's history and performed an assessment. The nurse will plan to prepare the child for which additional diagnostic test first?

complete blood cell count (CBC)

A child is scheduled for chemotherapy as treatment for leukemia. As the nurse is collaborating with another colleague, the discussion turns to the client's first phase of chemotherapy. This phase is known as:

induction.

The nurse is reviewing the medical record of a child diagnosed with Hodgkin lymphoma at the asymptomatic stage. Which would the nurse identify as typically the first sign reported by the child?

painless, enlarged lymph node

While assessing an adolescent, the nurse notes pallor and a beefy red tongue. Upon questioning, the adolescent reports eating a vegetarian diet to help with weight loss. Which health care provider prescription will the nurse anticipate?

vitamin B12 injections

While administering a blood transfusion to a child with a hematologic disorder, the nurse notes the child develops urticaria and wheezing. Which collaborative interventions will the nurse begin? Select all that apply.

- Discontinue the transfusion. - Give an antihistamine. - Apply oxygen as needed.

The nurse is assessing children in an ambulatory clinic. Which child would be most likely to have iron-deficiency anemia?

A 15-year-old adolescent who has heavy menstrual periods

A nurse is reviewing the medical records of several children who have undergone lead screening. The nurse would identify the child with which lead level as requiring no further action?

8 mcg/dl