PED PREPU chapter 24: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder - exam 2

In discussing the causes of iron-deficiency anemia in children with a group of nurses, the following statements are made. Which of these statements is a misconception related to iron-deficiency anemia? "A family's economic problems are often a cause of malnutrition." "Milk is a perfect food, and babies should be able to have all the milk they want." "Caregivers sometimes don't understand the importance of iron and proper nutrition." "Children have a hard time getting enough iron from food during their first few years."

"Milk is a perfect food, and babies should be able to have all the milk they want."

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 occurs from a random genetic mutation." "Sickle cell disease is passed to a fetus when both parents have the gene." "Sickle cell disease is passed to a fetus when one of the parents has the gene." "Sickle cell diseas can be passed to the fetus in many ways. We will know more at birth."

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

The pediatric nurse examines the radiographs of a client that indicate lesions on the bone. This finding is indicative of: Ewing sarcoma. Hodgkin disease. non-Hodgkin lymphoma. neuroblastoma.

Ewing sarcoma.

A high school football player has been diagnosed as having osteosarcoma of the femur. The parents are angry because they told their adolescent not to play football. Which health teaching points will the nurse include in the teaching plan for the adolescent and parents? Osteosarcoma often follows trauma, such as a football injury. There will be some discoloration of the leg following chemotherapy. Football injuries do not contribute to the development of a tumor. Tumor growth is related to the adolescent's dislike of milk.

Football injuries do not contribute to the development of a tumor.

Which site is most frequently used to perform a bone marrow aspiration? Humerus Iliac crest Rib cage Femur

Iliac crest Explanation: The preferred site for bone marrow aspiration in children is the iliac crest. The other sites are not used for a bone marrow aspiration.

What is the priority action the nurse should take when caring for a child newly diagnosed with Wilms tumor (nephroblastoma)? Protect the abdomen from manipulation. Assess for constipation. Control acute pain. Obtain a catheterized urine specimen.

Protect the abdomen from manipulation. Explanation: Manipulation can release malignant cells into the abdominal cavity. Constipation may be a problem following surgical intervention. Pain is uncommon; obtaining a urine specimen is not a priority.

A child is diagnosed with sickle cell anemia. Which test will the nurse expect the primary health care provider to prescribe for this client? Hemoglobin level Leukocyte level Thrombocyte level Metabolic screening test

Hemoglobin level

When providing care for a child immediately after a bone marrow aspiration, which nursing action is priority? Monitor the site dressing and vital signs. Evaluate pain and administer medication. Educate the family on proper handwashing. Allow the child to play with a doll and syringe.

Monitor the site dressing and vital signs.

A nurse is providing care to a toddler with nephroblastoma and is being evaluated. Which nursing action would be most important? Restricting the child's visitors Placing a "no abdominal palpation" sign above the child's bed Ensuring that the child be allowed nothing by mouth Preparing the child for chemotherapy Preventing weight-bearing activities

Placing a "no abdominal palpation" sign above the child's bed

A nurse is providing teaching to a child receiving chemotherapy and the parents. The nurse determines that the teaching was successful when the parents state that they will contact the primary health care provider if which occurs? The child has no appetite because of nausea. The child has increased urinary output or vomiting. The child has redness or swelling at the central venous access site. The child has a bruise on the arm.

The child has redness or swelling at the central venous access site.

A hospice nurse is providing at-home care to a child with end-stage cancer. The nurse is developing a plan of care to manage the child's pain. Which medications will the nurse likely include? mild analgesics topical anesthetics opioids sedatives

opioids

The nurse is assessing a school-aged child with sickle-cell anemia. Which assessment finding is consistent with this child's diagnosis? slightly yellow sclera enlarged mandibular growth increased growth of long bones depigmented areas on the abdomen

slightly yellow sclera Explanation: In sickle-cell anemia, eye scleras become icteric or yellowed from the release of bilirubin from the destruction of the sickled cells. Mandibular and long bone growth and depigmentation are not manifestations of this health problem.

The nurse is caring for a toddler taking ferrous sulfate for severe iron-deficiency anemia. Which report by the parent is most concerning? "I brush my child's teeth once every day." "My child's stools are darker than usual." "I mix ferrous sulfate with milk in a bottle." "My child takes ferrous sulfate after meals."

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

he nurse is caring for a 10-year-old boy with hemophilia. He asks the nurse for suggestions about appropriate physical activities. Which activity would the nurse most likely recommend? Baseball Football Wrestling Soccer

Baseball

Which intervention is best to use with the 6-year-old who has developed stomatitis as a side effect of chemotherapy? Limit foods to cool, clear liquids Practice frequent, gentle oral hygiene Use lidocaine rinses Have the child freely choose desired foods and beverages

Practice frequent, gentle oral hygiene

A child diagnosed with hemophilia presents with warm, swollen, painful joints. Which action will the nurse take first? Document the presence of hemarthrosis in the client's chart Notify the client's primary health care provider Assess the client's urine and stool for blood Prepare to administer factor replacement medication

Prepare to administer factor replacement medication

A child with cancer is dying and in hospice care. When developing the plan of care, which intervention should the nurse include as the primary focus? keeping the child pain-free managing the symptoms of dyspnea providing emotional support delivering appropriate developmental care

keeping the child pain-free

The nurse is reinforcing teaching with a group of caregivers of children diagnosed with iron-deficiency anemia. One of the caregivers tells the group, "I give my child ferrous sulfate." Which statement made by the caregivers is correct regarding giving ferrous sulfate? "When I give my son ferrous sulfate I know he also needs potassium supplements." "I always give the ferrous sulfate with meals." "My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C." "We watch closely for any diarrhea since that usually happens when he takes ferrous sulfate."

"My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C."

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 MRI is a nuclear scanning test to rule out cancer involving the bones or determine extent of bone involvement." "The MRI uses sound waves to create images that visualize body structures and locate masses." "The MRI uses radiation to examine soft tissue and bony structures of the body."

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

A client with cancer is diagnosed with typhlitis. Which emergency intervention would the nurse perform? Administer broad-spectrum antibiotics intravenously. Maintain fluid restriction to below maintenance levels. Monitor serum sodium levels. Administer diuretics.

Administer broad-spectrum antibiotics intravenously. Explanation: Typhlitis (neutropenic enterocolitis) is an inflammatory process of the gastrointestinal tract that occurs with the induction phase of leukemia chemotherapy. The recommended interventions for treatment are to administer broad-spectrum antibiotics or antifungals intravenously, provide supportive care to manage symptoms, and provide IV nutrition. The client should be kept NPO. The nurse should assess for any signs of bowel perforation or shock. Administering diuretics would not be needed and may cause harm. Monitoring sodium levels as well as other electrolytes would be necessary to evaluate IV nutrition.

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. The nurse receives orders for the child. Click to highlight the order(s) that needs to be implemented immediately. Orders: Administer acetaminophen for headache or temperature greater than 101°F (38.3°C). 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. Initiate a regular diet as tolerated.

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.

How can the nurse most simply describe for distressed parents a rhabdomyosarcoma that has been found in their 5-year-old? Call it a tumor of muscle tissue Describe it as a bone tumor Explain that it develops in nerves outside the brain and spinal cord Indicate that the more commonly used name is Hodgkin lymphoma

Call it a tumor of muscle tissue Explanation: A rhabdomyosarcoma is a tumor of striated muscle that most commonly develops in the head, neck, arms, and legs, as well as in the genitourinary tract, of children

A nursing student compares and contrasts childhood and adult cancers. Which statement does so accurately? Adult cancers are more responsive to treatment than are those in children. Children's cancers, unlike those of adults, often are detected accidentally, not through screening. Environmental and lifestyle influences in children are strong, unlike those in adults. Little is known regarding cancer prevention in adults, although much prevention information is available for children.

Children's cancers, unlike those of adults, often are detected accidentally, not through screening.

An adolescent receiving chemotherapy has lost all hair and is sad about self-image. Which action should the nurse take to support this adolescent and involve the client in decision making? Encourage the adolescent to select hats or wigs to fit one's personality. Refer the adolescent to a peer support group. Have a Child Life specialist work with the adolescent. Support the adolescent's choice of comfortable clothing

Encourage the adolescent to select hats or wigs to fit one's personality.

The nurse is caring for a child who had a stem cell transplant and is being monitored for engraftment. Which nursing action is priority? Encourage therapeutic play activities. Monitor daily complete blood count (CBC). Ensure neutropenic precautions are in place. Remind parents to contact the child's school.

Ensure neutropenic precautions are in place. Explanation: With stem cell transplants, children are at greatest risk for infection and sepsis. The nurse should ensure neutropenic precautions are used to reduce the change of infection. Monitoring laboratory values, reminding the parent to contact the school, and encouraging therapeutic play are important, but preventing infection in the immunocompromised child is a priority.

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 Hodgkin disease non-Hodgkin lymphoma neuroblastoma

Ewing sarcoma Explanation: Radiographs that show lesions on the bone may indicate tumors (e.g. Ewing sarcoma, osteosarcoma) or metastases of tumors warranting further investigation by bone scan, CT or MRI. Positron emission tomography is the most effective test to diagnose neuroblastoma, Hodgkin disease, non-Hodgkin lymphoma, bone tumors, lung and colon cancers and brain tumors.

The parent contacts the health care provider because their preschool-age 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? Instruct the parent to administer acetaminophen every 4 hours until the fever dissipates. Ask whether any family members or other close associates are ill. Have the parent bring the child to the pediatric oncology clinic as soon as possible. Instruct the parent to immediately obtain and give the antibiotic that the oncologist calls in to the pharmacy.

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

The parents of a child with a bleeding disorder ask the nurse about appropriate activities and sports that they should encourage the child to participate in. What activity would be the safest for the nurse to suggest? Soccer Gymnastics Rugby Swimming

Swimming Explanation: Swimming, a noncontact activity, would be the safest for the nurse to recommend. Soccer and gymnastics may be appropriate; however, these are considered riskier. Rugby would not be recommended because the risks outweigh the benefits

The nurse will select which meal as the best choice for a child with iron-deficiency anemia? cheeseburger, broccoli, and fresh strawberries chicken breast, French fries, and sweetened tea peanut butter sandwich, cheese stick, and applesauce two slices of pepperoni pizza and a glass of skim milk

cheeseburger, broccoli, and fresh strawberries

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? urinalysis complete blood cell count (CBC) bone marrow aspiration magnetic resonance imaging (MRI)

complete blood cell count (CBC)

The nurse is assessing the laboratory results of a child receiving chemotherapy. Which agent should the nurse anticipate administering to this child after noting a significant reduction in red blood cells (RBCs)? epoetin alfa filgrastim sargramostim gamma interferon

epoetin alfa Explanation: Epoetin alfa is a colony-stimulating factor used to stimulate production of red blood cells. Filgrastim is a colony-stimulating factor used to stimulate production of granulocytes. Sargramostim is a colony-stimulating factor used to stimulate production of granulocytes. Gamma interferon is used to stimulate macrophage production to fight bacteria and fungus.

The nurse is providing care for a 13-year-old child diagnosed with iron-deficiency anemia. The client's current hemoglobin level is 11 g/dL (110 g/L). Which intervention will the nurse anticipate including in the client's care? giving ferrous sulfate with orange juice between meals packed red blood cell transfusions providing a high dose of intravenous immunoglobulin weekly increasing the daily intake of fresh fruits and vegetables

giving ferrous sulfate with orange juice between meals

A child with cancer has developed neutropenia and is in isolation with neutropenic precautions. What nursing assessment takes priority for this child? infection symptoms vital signs mucositis bleeding

infection symptoms

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: destroy any remaining cancer cells. kill enough cancerous cells to induce remission. destroy any residual cancer cells. follow up for recurrent disease or late effects.

kill enough cancerous cells to induce remission.

The nurse develops a meal plan for a child with iron-deficiency anemia. Which meal would the nurse teach the parent has the highest amount of iron? red meat, eggs, oatmeal, and dried fruit chicken, corn, brown rice, and oranges pork, broccoli, white rice, and strawberries tuna salad with eggs, whole wheat crackers, and blueberries

red meat, eggs, oatmeal, and dried fruit