Pediatrics Hematology and Oncology Exam Review

A nurse is caring for a child with hemophilia who has developed hemarthrosis. Based on the nurse's understanding of hemarthrosis, the nurse knows to assess for which of the following? 1. Joint pain and swelling 2. Frequent epistaxis 3. Decreased grip strength 4. Purpura over the face and neck

1. "Joint pain and swelling" is correct. Hemarthrosis is a condition that develops as bleeding into a joint space. A client with hemophilia may suffer from hemarthrosis as one manifestation of easy bleeding and bruising. Signs and symptoms of this condition include joint pain and swelling, warmth and redness over a joint, and difficulties with movement. "Frequent epistaxis" is incorrect. Hemarthrosis involves internal bleeding into the joint space, not epistaxis. "Decreased grip strength" is incorrect. Hemarthrosis does affect range of motion of the affected joints, but does not affect muscle strength. "Purpura over the face and neck" is incorrect. Hemarthrosis does not cause purpura.

The nurse is caring for a 3-year-old boy with a diagnosis of acute lymphocytic leukemia. The child is crying and complaining that his knees hurt. Which nursing intervention is most appropriate? 1. Administer acetaminophen to the child. 2. Involve the child in a diversional activity. 3. Ask the child if he would like a "baby aspirin." 4. Apply heat to the child's knees and elevate the knees on a pillow.

1. Acetaminophen is acceptable and does not have anticoagulant properties. Diversional activities would not relieve the pain. Aspirin is not administered to the child with acute lymphocytic leukemia (ALL) because of its anticoagulant properties, and administering aspirin could lead to bleeding in the joints. Heat also would increase the pain by increasing circulation to the area.

A child is brought to the emergency department after falling from a high swing and landing on the back. The nurse notes that the client also has hemophilia. Based on the client's history and the nature of the injury, which should the nurse assess for first? 1. Blood in the urine 2. Oxygen saturation 3. Presence of headache 4. Presence of slurred speech

1. Because the kidneys are located in the flank region of the body, trauma to the back area can cause hematuria, particularly in the child with hemophilia. The nurse would be most concerned about the child's airway and respiratory rate if the child sustained an injury to the neck region. Headache and slurred speech are associated with head trauma.

A 10 year old boy has been admitted to the hospital for leukemia. What kind of precautions are you going to initiate for this patient? 1. Protective 2. Contact 3. Droplet 4. Airborne

1. Children with Rubeola (measles) need to be in airborne precautions. Children with Mumps need to be in droplet precautions. Children with Varicella (Chicken pox) need to be in airborne precautions. Children with Pertussis (Whooping cough) need to be in droplet precautions. Protective precautions are for children with low WBC counts in situations like leukemia.

A 27-year-old patient with hemophilia is seen at the care clinic with acute hemarthrosis. Which of the following best describes this condition? 1. The process of bleeding in a joint 2. The growth of bacteria and infection that develops in a joint 3. Development of fluid under the fascia that compresses the underlying nerves and joints 4. The deposit of uric acid crystals into the joint capsule

1. Hemarthrosis occurs when there is bleeding into the joint space. It may develop among people who have clotting disorders and are more prone to bleeding, such as those with hemophilia. Hemarthrosis can cause joint pain and swelling, eventually leading to disability if the condition is not managed. The patient may need pain medication and may need to have the fluid aspirated out of the joint space.

The nurse is reviewing the laboratory and diagnostic test results of a 5-year-old child scheduled to be seen in the clinic. The nurse notes that the health care provider documented that diagnostic studies revealed the presence of Reed-Sternberg cells. The nurse prepares to assist the health care provider to discuss which initial procedure with the parents? 1. Chemotherapy 2. Surgical biopsy 3. High-dose radiation 4. Intravenous antibiotics

1. Hodgkin's disease is a neoplasm of lymphatic tissue. The presence of giant, multinucleated cells (Reed-Sternberg cells) is the hallmark of this disease. Initially the nurse should prepare the child for diagnostic procedures and a surgical biopsy. Once Hodgkin's disease is confirmed, induction chemotherapy is then begun as soon as the child is stable and staging of the disease has been completed. High-dose radiation may be used if the disease is detected in a single site or in full-grown adolescents but usually is not the initial treatment in small children. Hodgkin's disease is cancer, not a bacterial infection.

A 2-year-old boy with a diagnosis of hemophilia is admitted to the hospital with bleeding into the joint of the right knee. Which intervention should the nurse plan to implement with this child? 1. Measure the injured knee joint every shift. 2. Take the temperature by rectal method only. 3. Administer acetylsalicylic acid for pain control. 4. Immobilize the joint and apply moist heat to the joint.

1. Interventions for bleeding into the joint include measuring the injured joint to assess for progression of the bleeding. This provides objective rather than subjective data, which are needed to determine if the bleeding is increasing. Rectal temperatures can cause tissue trauma, causing further bleeding. The application of heat and the administration of acetylsalicylic acid will increase bleeding.

The nurse analyzes the laboratory values of a child with leukemia who is receiving chemotherapy. The nurse notes that the platelet count is 19,500 mm3 (19.5 × 109/L). On the basis of this laboratory result, which intervention should the nurse include in the plan of care? 1. Initiate bleeding precautions. 2. Monitor closely for signs of infection. 3. Monitor the temperature every 4 hours. 4. Initiate protective isolation precautions.

1. Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia). If a child is severely thrombocytopenic and has a platelet count less than 20,000 mm3 (20.0 × 109/L), bleeding precautions need to be initiated because of the increased risk of bleeding or hemorrhage. Precautions include limiting activity that could result in head injury, using soft toothbrushes, checking urine and stools for blood, and administering stool softeners to prevent straining with constipation. In addition, suppositories, enemas, and rectal temperatures are avoided. Options 2, 3, and 4 are related to the prevention of infection rather than bleeding.

The nurse instructs the parents of a child with leukemia regarding measures related to monitoring for infection. Which statement, if made by the parent, indicates a need for further instructions? 1. "I will take a rectal temperature daily." 2. "I will inspect the skin daily for redness." 3. "I will inspect the mouth daily for lesions." 4. "I will perform proper hand washing techniques."

1. Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. The risk of injury to fragile mucous membranes and resultant bleeding is so high in the child with leukemia that tympanic or axillary temperatures should be taken. In addition, rectal abscesses can occur easily to damaged rectal tissue. No rectal temperatures should be taken. In addition, oral temperature taking should be avoided, especially if the child has oral ulcers. All other options are appropriate measures to prevent infection.

The nurse has reviewed the health care provider's prescriptions for a child suspected of a diagnosis of neuroblastoma and is preparing to implement diagnostic procedures that will confirm the diagnosis. What should the nurse expect to do next to assist in confirming the diagnosis? 1. Collect a 24-hour urine sample. 2. Perform a neurological assessment. 3. Assist with a bone marrow aspiration. 4. Send to the radiology department for a chest x-ray.

1. Neuroblastoma is a solid tumor found only in children. It arises from neural crest cells that develop into the sympathetic nervous system and the adrenal medulla. Typically, the tumor infringes on adjacent normal tissue and organs. Neuroblastoma cells may excrete catecholamines and their metabolites. Urine samples will indicate elevated vanillylmandelic acid levels. A bone marrow aspiration will assist in determining marrow involvement. A neurological examination and a chest x-ray may be performed but will not confirm the diagnosis.

The parents of a newborn want to speak with a nurse about the chances of their child developing sickle cell disease, since they both have family histories of the condition. Which information should the nurse provide to this family about testing? 1. Testing is performed automatically as part of the Newborn Screening Program 2. Most children are not tested unless they demonstrate signs of sickle cell crisis 3. Testing is done by assessing white blood cell counts and comparing them to red blood cell counts 4. The child cannot be tested until she turns 1 year of age

1. Sickle cell disease is an inherited condition known as a hemoglobinopathy, in which the red blood cells of the affected person are sickle shaped and do not flow through the bloodstream appropriately. Although these parents are at higher risk because the disease runs in their families, their newborn should be tested anyway as part of the mandated Newborn Screening Program.

The nurse is monitoring a 3-year-old child for signs and symptoms of increased intracranial pressure (ICP) after a craniotomy. The nurse plans to monitor for which early sign or symptom of increased ICP? 1. Vomiting 2. Bulging anterior fontanel 3. Increasing head circumference 4. Complaints of a frontal headache

1. The brain, although well protected by the solid bony cranium, is highly susceptible to pressure that may accumulate within the enclosure. Volume and pressure must remain constant within the brain. A change in the size of the brain, such as occurs with edema or increased volume of intracranial blood or cerebrospinal fluid without a compensatory change, leads to an increase in ICP, which may be life-threatening. Vomiting, an early sign of increased ICP, can become excessive as pressure builds up and stimulates the medulla in the brainstem, which houses the vomiting center. Children with open fontanels (posterior fontanel closes at 2 to 3 months; anterior fontanel closes at 12 to 18 months) compensate for ICP changes by skull expansion and subsequent bulging fontanels. When the fontanels have closed, nausea, excessive vomiting, diplopia, and headaches become pronounced, with headaches becoming more prevalent in older children.

The nurse is providing instructions to the mother of a 3-year-old child with hemophilia regarding care of the child. Which statement by the mother indicates a need for further teaching? 1. "I need to cancel the upcoming dental appointment that I made for my child." 2. "If my child gets a cut, I should hold pressure on it until the bleeding stops." 3. "I should check the house and remove any household items that can easily fall over." 4. "I should move furniture with sharp corners out of the way and pad the corners of the furniture."

1. The nurse needs to stress the importance of immunizations, dental hygiene, and routine well-child care. The remaining options are appropriate care measures. The mother is instructed regarding actions in the event of blunt trauma, especially trauma involving the joints, and is told to apply prolonged pressure to superficial wounds until the bleeding has stopped.

The home care nurse is providing safety instructions to the mother of a child with hemophilia. Which instruction should the nurse include to promote a safe environment for the child? 1. Eliminate any toys with sharp edges from the child's play area. 2. Allow the child to use play equipment only when a parent is present. 3. Allow the child to play indoors only, and avoid any outdoor play or playgrounds. 4. Place a helmet and elbow pads on the child every day as soon as the child awakens.

1. The nurse should instruct the mother to remove toys with sharp edges that may cause injury from the child's play area. It is not necessary to restrict play if safety measures have been implemented. It is not necessary that the child be restricted from outdoor play activity, but the activities that the child participates in should be monitored. Requiring that the child wear a helmet and elbow pads immediately on awakening and throughout the day is not necessary; however, these items should be worn during activities that could cause injury.

The mother of a 4-year-old child tells the pediatric nurse that the child's abdomen seems to be swollen. During further assessment of subjective data, the mother tells the nurse that the child is eating well and that the activity level of the child is unchanged. The nurse, suspecting the possibility of Wilms' tumor, should avoid which during the physical assessment? 1. Palpating the abdomen for a mass 2. Assessing the urine for the presence of hematuria 3. Monitoring the temperature for the presence of fever 4. Monitoring the blood pressure for the presence of hypertension

1. Wilms' tumor is the most common intraabdominal and kidney tumor of childhood. If Wilms' tumor is suspected, the tumor mass should not be palpated by the nurse. Excessive manipulation can cause seeding of the tumor and spread of the cancerous cells. Hematuria, fever, and hypertension are clinical manifestations associated with Wilms' tumor.

A client with anemia has a hemoglobin level of 7 mg/dL. Which of the following are appropriate nursing interventions for a client with this hemoglobin level? Select all that apply. 1. Monitor for cognitive changes 2. Support the client's activity levels as tolerated 3. Position the client supine with the head of the bed flat 4. Administer IV antibiotics 5. Provide supplemental oxygen as needed

1.2.5. "Monitor for cognitive changes", "Provide supplemental oxygen as needed", and "Support the client's activity levels as tolerated" are correct. Anemia occurs if a client's hemoglobin levels fall below a normal range. The client is at risk of decreased oxygenation when there are fewer red blood cells available to carry oxygen to the tissues. The nurse should monitor for cognitive changes that could develop, provide supplemental oxygen as needed, maintain large bore IV access, and be aware of the potential for a provider order for a blood transfusion. "Position the client supine with the head of the bed flat" is incorrect. Unless the client is symptomatic, no specific positioning is necessary. "Administer IV antibiotics" is incorrect. The client does not need IV antibiotics, because these do not affect hemoglobin levels.

Nursing care of the child with myelosuppression from leukemia or chemotherapeutic agents should include which intervention? 1. Restrict oral fluids. 2. Use good hand washing technique. 3. Give immunizations appropriate for age. 4. Institute strict isolation with no visitors allowed.

2. A child with myelosuppression is at risk for infection. Good hand washing technique is necessary to prevent the spread of infection. Restricting oral fluids would not be an intervention to reduce the risk of infection and could actually be harmful to the child. Live virus vaccines are not given when the child is myelosuppressed, so assessment of the child's immune status should be done before administration of immunizations appropriate for age. Strict isolation without visitors is not warranted, although visitors should wear a mask and gloves while in the child's room.

A 13-year-old child is diagnosed with Ewing's sarcoma of the femur. After a course of radiation and chemotherapy, it was decided that leg amputation is necessary. After the amputation, the child becomes very frightened because of aching and cramping felt in the missing limb. Which nursing statement is most appropriate to assist in alleviating the child's fear? 1. "The pain medication that I give you will take these feelings away." 2. "This aching and cramping is normal and temporary and will subside." 3. "This pain is not real pain, and relaxation exercises will help it go away." 4. "This normally occurs after the surgery, and we will teach you ways to deal with it."

2. After amputation, phantom limb pain is a temporary condition that some children experience. This sensation of burning, aching, or cramping in the missing limb is distressing to the child. The child needs to be reassured that the condition is normal and only temporary. All other options are not appropriate responses to the child, as they are incorrect or inappropriate statements.

A child is brought to the emergency department after being accidentally struck in the lower back region with a baseball bat. When gathering assessment data, the nurse discovers that the child has hemophilia. The nurse should immediately assess for which data? 1. Slurred speech 2. Presence of hematuria 3. Complaints of headache 4. Change in respiratory rate

2. Because the kidneys are located in the flank region of the body, trauma to the back area can cause hematuria, particularly in a child with hemophilia. The nurse would be most concerned about the child's airway and respiratory rate if the child had sustained an injury to the neck region. Slurred speech and headache are associated with head trauma.

The nurse is monitoring a child for bleeding after surgery for removal of a brain tumor. The nurse checks the head dressing for the presence of blood and notes a colorless drainage on the back of the dressing. Which intervention should the nurse perform immediately? 1. Reinforce the dressing. 2. Notify the health care provider (HCP). 3. Document the findings and continue to monitor. 4. Circle the area of drainage and continue to monitor.

2. Colorless drainage on the dressing in a child after craniotomy indicates the presence of cerebrospinal fluid and should be reported to the HCP immediately. Options 1, 3, and 4 are not the immediate nursing intervention because they do not address the need for immediate intervention to prevent complications.

An 11-year-old child is admitted to the hospital in vaso-occlusive sickle cell crisis. The nurse plans for which priority treatments in the care of the child? 1. Splenectomy, correction of acidosis 2. Adequate hydration, pain management 3. Frequent ambulation, oxygen administration 4. Passive range-of-motion exercises, adequate hydration

2. During vaso-occlusive sickle cell crisis, the care focuses on adequate hydration and pain management. Adequate hydration with intravenous normal saline and oral fluids maintains blood flow and decreases the severity of the vaso-occlusive crisis. Analgesics for pain management are necessary during a vaso-occlusive crisis. Splenectomy would not be done with a vaso-occlusive crisis. Acidosis is not present. Oxygen can be administered to increase tissue perfusion but is not the priority treatment for a vaso-occlusive crisis. Passive range of motion is not recommended; bed rest is prescribed initially.

The nurse is providing home care instructions to the mother of an infant who has just been found to have hemophilia. The nurse should tell the mother that care of the infant should include which appropriate measure? 1. Use aspirin for pain relief. 2. Pad crib rails and table corners. 3. Use a soft toothbrush for dental hygiene. 4. Use a generous amount of lubricant when taking a temperature rectally.

2. Establishment of an age-appropriate, safe environment is of paramount importance for hemophiliacs. Providing a safe environment for an infant includes padding table corners and crib rails, providing extra padding on clothes to protect the joints, observing a mobile infant at all times, and keeping items that can be pulled down onto the infant out of reach. Use of a soft toothbrush is an appropriate measure for a child with hemophilia but is not typically necessary for an infant. Rectal temperature measurements and the use of aspirin are contraindicated in hemophiliacs because of the risk of bleeding.

The nursing student is assigned to care for a child with hemophilia. The nursing instructor reviews the plan of care with the student. Which intervention on the student written plan of care requires correction? 1. Measure circumference of injured joints. 2. Blood transfusion of packed red blood cells. 3. Monitor temperature with oral thermometers. 4. Intravenous administration of recombinant factor.

2. Hemophilia is a lifelong hereditary blood disorder associated with deficiency of clotting factors. It is inherited in a recessive manner via a genetic defect on the X chromosome. Hemophilia A results from a deficiency of factor VIII. Hemophilia B (Christmas disease) is a deficiency of factor IX. Blood product transfusion is not the treatment of choice over administering recombinant factors intravenously. Measuring circumference of injured joints is appropriate to assess for enlarging hematomas or bleeding under the skin. The nurse should avoid taking rectal temperatures to decrease the risk for injury.

A 9-year-old child with leukemia is in remission and has returned to school. The school nurse calls the mother of the child and tells the mother that a classmate has just been diagnosed with chickenpox. The mother immediately calls the clinic nurse because the leukemic child has never had chickenpox. Which is an appropriate response by the clinic nurse to the mother? 1. "There is no need to be concerned." 2. "Bring the child into the clinic for a vaccine." 3. "Keep the child out of school for a 2-week period." 4. "Monitor the child for an elevated temperature, and call the clinic if this happens."

2. Immunocompromised children are unable to fight varicella adequately. Chickenpox can be deadly to the immunocompromised child. If an immunocompromised child who has not had chickenpox is exposed to someone with varicella, the child should receive varicella-zoster immune globulin within 96 hours of exposure. All other options are incorrect because they do nothing to minimize the chances of developing the disease.

The client needs a nephrostomy tube. How do you explain this to the client? 1. The tube is placed through the ureter into the renal pelvis. 2. The tube is placed directly into the kidney to drain urine. 3. The tube is placed in the ureter above the site of the blockage. 4. The tube is placed into the renal cortex to facilitate excretion.

2. In a nephrostomy tube, the tube is placed directly into the kidney in order to drain urine from the kidney.

The nurse is instructing the parents of a child with iron deficiency anemia regarding the administration of a liquid oral iron supplement. Which instruction should the nurse tell the parents? 1. Administer the iron at mealtimes. 2. Administer the iron through a straw. 3. Mix the iron with cereal to administer. 4. Add the iron to formula for easy administration.

2. In iron deficiency anemia, iron stores are depleted, resulting in a decreased supply of iron for the manufacture of hemoglobin in red blood cells. An oral iron supplement should be administered through a straw or medicine dropper placed at the back of the mouth because the iron stains the teeth. The parents should be instructed to brush or wipe the child's teeth or have the child brush the teeth after administration. Iron is administered between meals because absorption is decreased if there is food in the stomach. Iron requires an acid environment to facilitate its absorption in the duodenum. Iron is not added to formula or mixed with cereal or other food items.

A child with sickle cell anemia who is in vaso-occlusive crisis is admitted to the hospital. Which health care provider prescription would assist in reversing the vaso-occlusive crisis? 1. Monitor pulse oximetry. 2. Begin intravenous fluids. 3. Administer oxygen by face mask. 4. Monitor vital signs and respiratory status.

2. Increased fluid volume reduces the viscosity of the blood, preventing further vascular occlusion and further sickling caused by dehydration. Pulse oximetry and vital sign monitoring may be components of care, but they are actions that relate to monitoring the client versus treating. The intravenous fluids, however, will treat the condition. Vaso-occlusive crisis treatment includes analgesic and fluid administration. Oxygen may help relieve symptoms of respiratory distress, but analgesics and fluids treat the condition.

A 4-year-old child is admitted to the hospital for abdominal pain. The mother reports that the child has been pale and excessively tired and is bruising easily. On physical examination, lymphadenopathy and hepatosplenomegaly are noted. Diagnostic studies are being performed because acute lymphocytic leukemia is suspected. The nurse determines that which laboratory result confirms the diagnosis? 1. Lumbar puncture showing no blast cells 2. Bone marrow biopsy showing blast cells 3. Platelet count of 350,000 mm3 (350 × 109/L) 4. White blood cell count 4,500 mm3 (4.5 × 109/L)

2. Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. The confirmatory test for leukemia is microscopic examination of bone marrow obtained by bone marrow aspirate and biopsy, which is considered positive if blast cells are present. An altered platelet count occurs as a result of the disease, but also may occur as a result of chemotherapy and does not confirm the diagnosis. The white blood cell count may be normal, high, or low in leukemia. A lumbar puncture may be done to look for blast cells in the spinal fluid that indicate central nervous system disease.

The nurse provides a teaching session to the nursing staff regarding osteosarcoma. Which statement by a member of the nursing staff indicates a need for information? 1. "The femur is the most common site of this sarcoma." 2. "The child does not experience pain at the primary tumor site." 3. "Limping, if a weight-bearing limb is affected, is a clinical manifestation." 4. "The symptoms of the disease in the early stage are almost always attributed to normal growing pains."

2. Osteosarcoma is the most common bone cancer in children. Cancer usually is found in the metaphysis of long bones, especially in the lower extremities, with most tumors occurring in the femur. Osteosarcoma is manifested clinically by progressive, insidious, and intermittent pain at the tumor site. By the time these children receive medical attention, they may be in considerable pain from the tumor. Options 1, 3, and 4 are accurate regarding osteosarcoma.

The pediatric nurse specialist provides a teaching session to the nursing staff regarding osteosarcoma. Which statement by a member of the nursing staff indicates a need for information? 1. "The femur is the most common site of this sarcoma." 2. "The child does not experience pain at the primary tumor site." 3. "Limping, if a weight-bearing limb is affected, is a clinical manifestation." 4. "The symptoms of the disease in the early stage are almost always attributed to normal growing pains."

2. Osteosarcoma is the most common bone cancer in children. Cancer usually is found in the metaphysis of long bones, especially in the lower extremities, with most tumors occurring in the femur. Osteosarcoma is manifested clinically by progressive, insidious, and intermittent pain at the tumor site. By the time these children receive medical attention, they may be in considerable pain from the tumor. The statements in the remaining options are accurate regarding osteosarcoma.

A client has been diagnosed with sickle cell anemia, the nurse should educate the client on prevention of a sickle cell crises. What would be the best advice for the nurse to give the client? 1. Promote lots of rest 2. Increase fluid intake 3. Increase exercise 4. Decrease fatty food intake

2. Sickle Cell Crises occur usually because of dehydration, encouraging fluids and hydration of the client will help to prevent sickling of the cells.

The pediatric nursing instructor asks a nursing student to prioritize care for a child diagnosed with sickle cell disease. Which student response correctly identifies the priority of care? 1. Fatigue 2. Hypoxia 3. Delayed growth 4. Avascular necrosis

2. Sickle cell disease is a group of diseases termed hemoglobinopathies, in which hemoglobin A is partly or completely replaced by abnormal sickle hemoglobin S. It is caused by the inheritance of a gene for a structurally abnormal portion of the hemoglobin chain. Hemoglobin S is sensitive to changes in the oxygen content of the red blood cell. Hypoxia causes the cells to assume a sickle shape, and the cells become rigid and clumped together, obstructing capillary blood flow and leading to a vaso-occlusive crisis. All the clinical manifestations of sickle cell anemia result from the sickled cells being unable to flow easily through the microvasculature, and their clumping obstructs blood flow. With reoxygenation most of the sickled red blood cells resume their normal shape. Fatigue is a result of hypoxia; hypoxia should be addressed first. Avascular necrosis of the hips and shoulders and delayed growth are general manifestations of sickle cell disease.

The nurse is providing home care instructions to the mother of a child receiving radiation therapy. Which statement by the mother indicates a need for further teaching? 1. "I should dress my child in loose-fitting clothing." 2. "I won't need to limit the amount of sun that my child gets." 3. "My child may experience fatigue and need more rest periods." 4. "I need to try to provide food and fluids to prevent dehydration."

2. Sun protection is essential during radiation treatments. The child should not be exposed to sun during these treatments because of the risk of an alteration of skin integrity. The statements in the remaining options reflect appropriate measures for the child during radiation therapy.

An 8-year-old child must have a transfusion of whole blood following an acute hemorrhage. As the nurse is preparing the child for the transfusion, which of the following actions is most appropriate to relieve the child's fears about the blood? 1. When the bag arrives, let the child handle it and look at it 2. Ask the parents to hold the child while the blood is being administered 3. Talk to the child about what the blood will look like and how it will feel going in before starting the transfusion 4. Cover the bag so that the child cannot see it during the transfusion

3. "Talk to the child about what the blood will look like and how it will feel going in before starting the transfusion" is correct. When working with a child who must have a blood transfusion, the nurse can explain to the child what will happen and how the transfusion will feel, if the child is old enough to understand. An 8-year-old child should be able to understand some of the concepts of blood and the body and the nurse can ease some of his fears by talking to him about the blood before starting the transfusion. "When the bag arrives, let the child handle it and look at it" is incorrect because when giving a blood transfusion, allowing a child to handle the bag can result in greater risk of contamination. The nurse should not offer to have the child handle the blood. "Cover the bag so that the child cannot see it during the transfusion" is incorrect. It is important for the nurse to be able to visualize the blood bag during administration. Additionally, a school-age child typically has the ability to understand the reason for their treatment, and since the nurse has explained the procedure in terms the child can understand, there is no need to hide the blood. "Ask the parents to hold the child while the blood is being administered" is incorrect. For a school-age child, it is important to allow the child some control over their body and the situation. Asking a parent to hold the child could increase anxiety in the child.

A 10-year-old child with hemophilia A has slipped on the ice and bumped his knee. The nurse should prepare to administer which prescription? 1. Injection of factor X 2. Intravenous infusion of iron 3. Intravenous infusion of factor VIII 4. Intramuscular injection of iron using the Z-track method

3. Hemophilia refers to a group of bleeding disorders resulting from a deficiency of specific coagulation proteins. The primary treatment is replacement of the missing clotting factor; additional medications, such as agents to relieve pain, may be prescribed depending on the source of bleeding from the disorder. A child with hemophilia A is at risk for joint bleeding after a fall. Factor VIII would be prescribed intravenously to replace the missing clotting factor and minimize the bleeding. Factor X and iron are not used to treat children with hemophilia A.

In caring for a child diagnosed with Hodgkin's disease. Which oncologic emergency should the nurse be most concerned about? 1. Hyperleukocytosis 2. Spinal cord compression 3. Superior vena cava syndrome 4. Disseminated intavascular coagulation

3. Pediatric oncologic emergencies include tumor lysis syndrome, hyperleukocytosis, superior vena cava syndrome, spinal cord compression, and disseminated intravascular coagulation. Because Hodgkin's disease causes a space-occupying lesion in the chest, superior vena cava syndrome is the most likely emergency that will occur with this type of malignancy. This complication could lead to airway compromise and respiratory failure. The other complications are possible, due to issues with immune response, treatment response, and obstruction, but are less likely to occur due to lesion location in Hodgkin's disease.

A nursing student is assigned to care for a child with sickle cell disease (SCD). The nursing instructor asks the student to describe the causative factors related to this disease. Which statement by the student indicates a need for further research? 1. SCD is an autosomal recessive disease. 2. Children with the HbS (sickle cell hemoglobin) trait are not symptomatic. 3. If each parent carries the trait, the child will carry the trait, and the probability of the child having the disease is 75%. 4. If one parent has the HbS trait and the other parent is normal, there is a 50% chance that each offspring will inherit the trait.

3. SCD is an autosomal recessive disease. Children with the HbS trait are not symptomatic. If one parent has the HbS trait and the other parent is normal, there is a 50% chance that each offspring will inherit the trait. If each parent carries the trait, there is a 25% chance that their child will be normal, a 50% chance that the child will carry the trait, and a 25% chance that each child will have the disease.

A client reports to the nurse that she is having a sickle cell crisis. The nurse knows that the client will have which abnormal lab? 1. Platelets 2. Neutrophils 3. Red Blood Cells 4. Leukocytes

3. Sickle Cell Anemia is a condition where the RBCs can become sickled and hemolyze. The client will have low RBCs. WBC such as leukocytes and neutrophils will not be abnormal from the sickle cell crisis, neither will the plateles, which are used for clotting.

The nurse is collecting data on a 9-year-old child suspected of having a brain tumor. Which question should the nurse ask to elicit data related to the classic symptoms of a brain tumor? 1. "Do you have trouble seeing?" 2. "Do you feel tired all the time?" 3. "Do you throw up in the morning?" 4. "Do you have headaches late in the day?"

3. The classic symptoms of children with brain tumors are headache and morning vomiting related to the child getting out of bed. Headaches worsen on arising but improve during the day. Fatigue may occur but is a vague symptom. Visual changes may occur, including nystagmus, diplopia, and strabismus, but these signs are not the hallmark symptoms with a brain tumor.

The nurse is monitoring for bleeding in a child following surgery for removal of a brain tumor. The nurse checks the head dressing and notes the presence of dried blood on the back of the dressing. The child is alert and oriented, and the vital signs and neurological signs are stable. Which nursing action is most appropriate initially? 1. Prepare to change the dressing. 2. Recheck the dressing in 1 hour. 3. Check the operative record to determine whether a drain is in place. 4. Document the findings and notify the health care provider immediately.

3. The initial nursing action is to determine whether a drain is in place because the drainage seen on the dressing could be attributed to this. The nurse would not change the dressing without a health care provider's prescription. Rechecking the dressing is an appropriate action, but it is not the initial action. The findings would be documented; however, there is no reason to notify the health care provider immediately. The initial action would be to further assess the cause of the drainage.

The nurse is reviewing the laboratory results of a child with aplastic anemia and notes that the white blood cell count is 2000 mm3 (2 × 109/L) and that the platelet count is 150,000 mm3 (150 × 109/L). Which intervention should the nurse incorporate into the plan of care? 1. Avoid unnecessary injections. 2. Encourage quiet play activities. 3. Maintain strict neutropenic precautions. 4. Encourage the child to use a soft toothbrush.

3. The normal white blood cell (WBC) count ranges from 5000 to 10,000 mm3 (5 to 10 × 109/L) and the normal platelet count ranges from 150,000 to 400,000 mm3 (150 to 400 × 109/L). Strict neutropenic procedures would be required if the WBC count were low to protect the child from infection. Precautionary measures to prevent bleeding should be taken when a child has a low platelet count. These include no injections, no rectal temperatures, use of a soft toothbrush, and abstinence from contact sports or activities that could cause an injury.

The nurse provides instructions regarding home care to the parents of a 3-year-old child hospitalized with hemophilia. Which statement, if made by the parent, indicates a need for further instructions? 1. "We will supervise our child closely." 2. "We will pad corners of the furniture." 3. "We will avoid having our child receive immunizations." 4. "We will remove household items that can easily fall over."

3. The nurse needs to stress the importance of immunizations, dental hygiene, and routine well-child care. The remaining options are appropriate. The parents also are instructed in the measures to implement in the event of blunt trauma, especially trauma involving the joints, and taught to apply prolonged pressure to superficial wounds until the bleeding has stopped.

A nurse is performing the initial assessment of a child with a history of acute leukemia who was brought into the emergency department. The nurse discovers the child has a temperature of 38.5C. Which action is the first priority in this situation? 1. Check a stool sample 2. Assess for signs of dehydration 3. Begin cooling the client with ice packs 4.Start an IV on the client

4. "Start an IV on the client" is correct. A child with leukemia is immunocompromised, which means they are extremely susceptible to infections. If an immunocompromised client presents with a fever over 38C, they require prompt attention to prevent potentially life-threatening sepsis. The nurse's first priority would be to start an IV so the child can receive extra fluids and antibiotics. "Assess for signs of dehydration" is incorrect because once fever is confirmed, the nurse knows this child will need IV access. Access should be established right away so IV therapy can begin. "Check a stool sample" is incorrect. Checking a stool sample is not a high priority in this situation, and the chances that it would be immediately available are slim. "Begin cooling the client with ice packs" is incorrect. The child with a temperature of 38.5C is not high enough to be at risk for seizure and does not need cooled.

A 12-year-old child with newly diagnosed thalassemia is brought to the clinic exhibiting delayed sexual maturation, fatigue, anorexia, pallor, and complaints of headache. The child seems listless and small for age and has frontal bossing. What should the nurse expect to note on review of the results of the laboratory tests? 1. Macrocytosis and hyperchromia 2. Excessive red blood cell production 3. Excessive mature erythrocyte proliferation 4. Deficient production of functional hemoglobin

4. Defective hemoglobin is produced as a result of genetically deficient beta-polypeptide. This hemoglobin is unstable, disintegrates, and damages the erythrocytes. Rapid destruction of the red cells stimulates rapid production of immature red cells, and the net gain is less than optimally functioning red cells. Iron from the red blood cell destruction is stored in the tissues, causing multiple problems. In thalassemia, immature erythrocytes proliferate, not mature ones. This is a progressive anemia. The nurse also would note microcytosis and hypochromia.

A client is hospitalized for a sickle cell crisis. What type of transfusion should they get if they are anemic? 1. Packed red cells mixed with D5W 2. Packed red blood cells to bring up hgb 3. Whole blood transfusion 4. Exchange transfusions

4. Giving packed red blood cells will increase viscosity and worsen sickling. The best treatment is an exchange transfusion that keeps the hgb stable but increases the ratio of normal to sickled cells.

The pediatric nurse educator provides a teaching session to the nursing staff regarding hemophilia. Which statement regarding this disorder should the nurse plan to include in the discussion? 1. Males inherit hemophilia from their fathers. 2. Hemophilia is a Y-linked hereditary disorder. 3. Females inherit hemophilia from their mothers. 4. Hemophilia A results from deficiency of factor VIII.

4. Hemophilia refers to a group of bleeding disorders resulting from a deficiency of specific coagulation proteins. Hemophilia A results from a deficiency of factor VIII. Males inherit hemophilia from their mothers, and females inherit the carrier status from their fathers. Hemophilia is inherited in a recessive manner via a genetic defect on the X chromosome. Hemophilia B (Christmas disease) is a deficiency of factor IX.

The nurse analyzes the laboratory results of a child with hemophilia. The nurse understands that which result will most likely be abnormal in this child? 1. Platelet count 2. Hematocrit level 3. Hemoglobin level 4. Partial thromboplastin time

4. Hemophilia refers to a group of bleeding disorders resulting from a deficiency of specific coagulation proteins. Results of tests that measure platelet function are normal; results of tests that measure clotting factor function may be abnormal. Abnormal laboratory results in hemophilia indicate a prolonged partial thromboplastin time. The platelet count, hemoglobin level, and hematocrit level are normal in hemophilia.

A diagnosis of Hodgkin's disease is suspected in a 12-year-old child. Several diagnostic studies are performed to determine the presence of this disease. Which diagnostic test result will confirm the diagnosis of Hodgkin's disease? 1. Elevated vanillylmandelic acid urinary levels 2. The presence of blast cells in the bone marrow 3. The presence of Epstein-Barr virus in the blood 4. The presence of Reed-Sternberg cells in the lymph nodes

4. Hodgkin's disease (a type of lymphoma) is a malignancy of the lymph nodes. The presence of giant, multinucleated cells (Reed-Sternberg cells) is the classic characteristic of this disease. Elevated levels of vanillylmandelic acid in the urine may be found in children with neuroblastoma. The presence of blast cells in the bone marrow indicates leukemia. Epstein-Barr virus is associated with infectious mononucleosis.

The nurse is asked to prepare for the admission of a child to the pediatric unit with a diagnosis of Wilms' tumor. The nurse is creating a plan of care for the child and should include which intervention in the plan? 1. Monitor the temperature for hypothermia. 2. Monitor the blood pressure for hypotension. 3. Palpate the abdomen for an increase in the size of the tumor. 4. Inspect the urine for the presence of hematuria at each voiding.

4. If Wilms' tumor is suspected, the tumor mass should not be palpated. Excessive manipulation can cause seeding of the tumor and cause spread of the cancerous cells. Fever (not hypothermia), hematuria, and hypertension (not hypotension) are clinical manifestations associated with Wilms' tumor.

The nurse is monitoring the laboratory values of a child with leukemia who is receiving chemotherapy. The nurse prepares to implement bleeding precautions if the child becomes thrombocytopenic and the platelet count is less than how many cells/mm3? 1. 200,000 mm3 (200 × 109/L) 2. 180,000 mm3 (180 × 109/L) 3. 160,000 mm3 (160× 109/L) 4. 150,000 mm3 (150 × 109/L)

4. If a child is thrombocytopenic, precautions need to be taken because of the increased risk of bleeding. The precautions include limiting activity that could result in head injury, using soft toothbrushes, checking urine and stools for blood, and administering stool softeners to prevent straining with constipation. Additionally, suppositories and rectal temperatures are avoided. The normal platelet count ranges from 150,000 to 400,000 mm3 (150 to 400 × 109/L).

The parents of a preschooler inform the nurse that their child often develops diarrhea and ask whether there might be anything wrong with the child's stomach. Upon assessment, the nurse also finds that the child has poor oral care and is at risk for dental caries. What is the most probable cause for the child's health issues? 1. The family often consumes fast foods. 2 The parents neglect the child's dietary needs. 3 The family does not follow hygienic practices. 4 The child consumes excessive amounts of fruit juice.

4. If the child consumes excessive fruit juice or sweetened beverages, it increases the risk for dental caries and gastrointestinal conditions, such as chronic diarrhea. Consuming fast foods often result in childhood obesity, because fast foods are high in fats and starches. Neglecting the dietary needs or not following hygienic practices may cause gastrointestinal problems or make the child susceptible to infections.

Laboratory studies are performed for a child suspected to have iron deficiency anemia. The nurse reviews the laboratory results, knowing that which result indicates this type of anemia? 1. Elevated hemoglobin level 2. Decreased reticulocyte count 3. Elevated red blood cell count 4. Red blood cells that are microcytic and hypochromic

4. In iron deficiency anemia, iron stores are depleted, resulting in a decreased supply of iron for the manufacture of hemoglobin in red blood cells. The results of a complete blood cell count in children with iron deficiency anemia show decreased hemoglobin levels and microcytic and hypochromic red blood cells. The red blood cell count is decreased. The reticulocyte count is usually normal or slightly elevated.

A child with a diagnosis of sickle cell anemia and vaso-occlusive crisis is complaining of severe pain, selecting number 8 on the 1 to 10 pain scale. Which medication would the nurse expect to be prescribed for pain control? 1. Ibuprofen 2. Meperidine 3. Acetaminophen 4. Morphine sulfate

4. Morphine sulfate is the medication of choice for severe pain for the child with sickle cell anemia. Opioids such as morphine sulfate provide systemic relief. Ibuprofen decreases inflammation locally. Meperidine has neurological adverse effects and can cause seizures and should be avoided. Acetaminophen would not provide adequate pain relief.

A diagnostic workup is being performed on a 1-year-old child with suspected neuroblastoma. The nurse reviews the results of the diagnostic tests and understands that which finding is most specifically related to this type of tumor? 1. Positive Babinski's sign 2. Presence of blast cells in the bone marrow 3. Projectile vomiting, usually in the morning 4. Elevated vanillylmandelic acid urinary levels

4. Neuroblastoma is a solid tumor found only in children. It arises from neural crest cells that develop into the sympathetic nervous system and the adrenal medulla. Typically, the tumor compresses adjacent normal tissue and organs. Neuroblastoma cells may excrete catecholamines and their metabolites. Urine samples will indicate elevated vanillylmandelic acid levels. The presence of blast cells in the bone marrow occurs in leukemia. Projectile vomiting occurring most often in the morning and a positive Babinski's sign are clinical manifestations of a brain tumor.

A child in whom sickle cell anemia is suspected is seen in a clinic, and laboratory studies are performed. The nurse checks the laboratory results, knowing that which value would be increased in this disease? 1. Platelet count 2. Hematocrit level 3. Hemoglobin level 4. Reticulocyte count

4. Sickle cell anemia is a group of diseases termed hemoglobinopathies, in which hemoglobin A is partly or completely replaced by abnormal sickle hemoglobin S. It is caused by the inheritance of a gene for a structurally abnormal portion of the hemoglobin chain. Hemoglobin S is sensitive to changes in the oxygen content of the red blood cell. Insufficient oxygen causes the cells to assume a sickle shape, and the cells become rigid and clumped together, obstructing capillary blood flow. A diagnosis is established on the basis of a complete blood count, examination for sickled red blood cells in the peripheral smear, and hemoglobin electrophoresis. Laboratory studies will show decreased hemoglobin level and hematocrit, a decreased platelet count, an increased reticulocyte count, and the presence of nucleated red blood cells. Reticulocyte counts are increased in children with sickle cell disease because the life span of their sickled red blood cells is shortened.

The clinic nurse instructs parents of a child with sickle cell anemia about the precipitating factors related to sickle cell crisis. Which, if identified by the parents as a precipitating factor, indicates the need for further instruction? 1. Stress 2. Trauma 3. Infection 4. Fluid overload

4. Sickle cell crises are acute exacerbations of the disease, which vary considerably in severity and frequency; these include vaso-occlusive crisis, splenic sequestration, hyperhemolytic crisis, and aplastic crisis. Sickle cell crisis may be precipitated by infection, dehydration, hypoxia, trauma, or physical or emotional stress. The mother of a child with sickle cell disease should encourage fluid intake of 1½ to 2 times the daily requirement to prevent dehydration.

The child client has sickle cell anemia. You explain to the family that the definitive treatment for sickle cell anemia is what? 1. Provide folate and iron in the diet. 2. Give a pneumococcal immunization. 3. Give repeated blood transfusions. 4.Do a bone marrow transplant.

4. The definitive treatment for sickle cell disease is to do a bone marrow transplant in childhood. Transfusions do not cure the disease and folate/iron supplementation will not help as this is a hemolytic disease.

The nurse on the pediatric unit is caring for a child with hemophilia who has been in a motor vehicle crash. Which assessment finding, if noted in the child, indicates the need for follow-up? 1. The child maintains affected joints in an immobilized position and denies pain at this time. 2. The child's urine is noted to be clear and light yellow and is negative for red blood cells. 3. The child maintains bruised joints in an elevated position; the bruises noted are beginning to turn yellow. 4. The child is drowsy and difficult to arouse; previously the child was able to respond to questions effectively.

4. When caring for a child with hemophilia who has sustained injuries, the nurse should monitor for signs of internal bleeding. One sign of internal bleeding is change in level of consciousness, which could indicate intracranial hemorrhage. Additional signs of bleeding include pain, tenderness, and bruising of the affected area and hematuria. Denial of pain of affected joints, clear and light yellow urine that is negative for red blood cells, and bruises that are beginning to turn yellow are not signs of internal or external bleeding.

A child with β-thalassemia is receiving long-term blood transfusion therapy for the treatment of the disorder. Chelation therapy is prescribed as a result of too much iron from the transfusions. Which medication should the nurse anticipate to be prescribed? 1. Fragmin 2. Meropenem 3. Metoprolol 4. Deferoxamine

4. β-Thalassemia is an autosomal recessive disorder characterized by the reduced production of 1 of the globin chains in the synthesis of hemoglobin (both parents must be carriers to produce a child with β-thalassemia major). The major complication of long-term transfusion therapy is hemosiderosis. To prevent organ damage from too much iron, chelation therapy with either Exjade or deferoxamine may be prescribed. Deferoxamine is classified as an antidote for acute iron toxicity. Fragmin is an anticoagulant used as prophylaxis for postoperative deep vein thrombosis. Meropenem is an antibiotic. Metoprolol is a beta blocker used to treat hypertension.

The parents of a 6-month old infant have brought her in for a routine well-child check. The parents want to know what immunizations their child should get at this visit. According to the Centers for Disease Control and Prevention recommendations, which vaccines should the child get at this age? Select all that apply. 1. Hepatitis B 2. Varicella 3. Polio 4. DTaP 5. MMR

1.3.4. The Centers for Disease Control and Prevention have recommendations for the type of immunizations a person should get based on age. A 6-month old patient should receive different immunizations when compared to an older child. For a 6-month old infant, the nurse would most likely need to administer DTaP, polio, Hib, and yearly influenza, as well as hepatitis B if the child has not received it.

A mother wants to donate her blood to her child who is having surgery, but discovers that she has a different blood type than her child. Which type of blood donation is the child most likely going to receive? 1. Allogeneic blood donation 2. Directed blood donation 3. Xenogeneic blood donation 4. Autologous blood donation

1. "Allogeneic blood donation" is correct because this refers to a normal whole blood donation to anyone other than the donor himself. 'Allogeneic' means taken from individuals of the same species, which is how all anonymous blood donation is done in the United States. "Directed blood donation" is incorrect because a directed blood donation involves a person donating blood specifically for the purpose of giving it to a certain person. The donor must meet the same requirements as in a regular blood donation, and all the standard protocols are still in place. The blood must match the recipient's blood and be free of infection. "Autologous blood donation" is incorrect because this involves a person donating blood to be stored for themselves to use later. "Xenogeneic blood donation" is incorrect because xenogeneic refers to an outside species.

Oral iron is prescribed for a child with iron deficiency anemia. The nurse provides instructions to the mother regarding the administration of the iron. The nurse should instruct the mother to administer the medication in which way? 1. Between meals 2. Just before a meal 3. Just after the meal 4. With a fruit low in vitamin C

1. The mother should be instructed to administer oral iron supplements between meals. The iron should be given with a citrus fruit or juice high in vitamin C because vitamin C increases the absorption of iron by the body.

A 14-year-old child is admitted to the hospital with a diagnosis of acute lymphocytic leukemia. She is receiving a combination chemotherapeutic regimen that includes cyclophosphamide. The nurse plans care understanding that which are associated with this medication? Select all that apply. 1. It is platelet sparing. 2. It causes constipation. 3. It causes hemorrhagic cystitis. 4. It causes bone marrow depression. 5. Increased fluid intake is necessary.

1.3.4.5. Cyclophosphamide is an alkylating agent used as a chemotherapeutic agent in children with leukemia and other cancers. It also causes hemorrhagic cystitis; therefore, increased fluid intake is necessary. It does not cause constipation. Its side/adverse effects include bone marrow depression (BMD), but it is platelet sparing.

The nurse is performing an assessment on a 10-year-old child suspected to have Hodgkin's disease. Which assessment findings are specifically characteristic of this disease? Select all that apply. 1. Abdominal pain 2. Fever and malaise 3. Anorexia and weight loss 4. Painful, enlarged inguinal lymph nodes 5. Painless, firm, and movable adenopathy in the cervical area

1.5. Hodgkin's disease (a type of lymphoma) is a malignancy of the lymph nodes. Specific clinical manifestations associated with Hodgkin's disease include painless, firm, and movable adenopathy in the cervical and supraclavicular areas and abdominal pain as a result of enlarged retroperitoneal nodes. Hepatosplenomegaly also is noted. Although fever, malaise, anorexia, and weight loss are associated with Hodgkin's disease, these manifestations are seen in many disorders.

The nurse is reviewing a health care provider's prescriptions for a child with sickle cell anemia who was admitted to the hospital for the treatment of vaso-occlusive crisis. Which prescriptions documented in the child's record should the nurse question? Select all that apply. 1. Restrict fluid intake. 2. Position for comfort. 3. Avoid strain on painful joints. 4. Apply nasal oxygen at 2 L/minute. 5. Provide a high-calorie, high-protein diet. 6. Give meperidine, 25 mg intravenously, every 4 hours for pain.

1.6. Sickle cell anemia is one of a group of diseases termed hemoglobinopathies, in which hemoglobin A is partly or completely replaced by abnormal sickle hemoglobin S. It is caused by the inheritance of a gene for a structurally abnormal portion of the hemoglobin chain. Hemoglobin S is sensitive to changes in the oxygen content of the red blood cell; insufficient oxygen causes the cells to assume a sickle shape, and the cells become rigid and clumped together, obstructing capillary blood flow. Oral and intravenous fluids are an important part of treatment. Meperidine is not recommended for a child with sickle cell disease because of the risk for normeperidine-induced seizures. Normeperidine, a metabolite of meperidine, is a central nervous system stimulant that produces anxiety, tremors, myoclonus, and generalized seizures when it accumulates with repetitive dosing. The nurse would question the prescription for restricted fluids and meperidine for pain control. Positioning for comfort, avoiding strain on painful joints, oxygen, and a high-calorie and high-protein diet are also important parts of the treatment plan.

The nurse is caring for a 9-year-old child with leukemia who is hospitalized for the administration of chemotherapy. The nurse would monitor the child specifically for central nervous system involvement by checking which item? 1. Pupillary reaction 2. Level of consciousness 3. The presence of petechiae in the sclera 4. Color, motion, and sensation of the extremities

2. The central nervous system (CNS) status is monitored in the child with leukemia because of the risk of infiltration of blast cells into the CNS. The nurse should check the child's level of consciousness (LOC) and should also monitor for signs of irritability, vomiting, and lethargy. Changes in pupillary reaction are specific to conditions related to increased intracranial pressure. The presence of petechiae in the sclera is an objective sign that may be noted in leukemia but is not specifically related to the CNS. Color, motion, and sensation of the extremities relate to a neurovascular assessment and are not specifically related to CNS status.

The nurse is providing home care instructions to the parents of a 10-year-old child with hemophilia. Which sport activity should the nurse suggest for this child? 1. Soccer 2. Basketball 3. Swimming 4. Field hockey

3. Hemophilia refers to a group of bleeding disorders resulting from a deficiency of specific coagulation proteins. Children with hemophilia need to avoid contact sports and to take precautions such as wearing elbow and knee pads and helmets with other sports. The safe activity for them is swimming.

The nurse is caring for a child with a diagnosis of hemophilia, and hemarthrosis is suspected because the child is complaining of pain in the joints. Which measure should the nurse expect to be prescribed for the child? 1. Range-of-motion exercises to the affected joint 2. Application of a heating pad to the affected joint 3. Application of a bivalved cast for joint immobilization 4. Nonsteroidal antiinflammatory drugs for the pain

3. In an acute period, immobilization of the joint would be prescribed. Range-of-motion exercise during the acute period can increase the bleeding and would be avoided at this time. Heat will increase blood flow to the area, so it would promote increased bleeding to the area. Nonsteroidal antiinflammatory drugs (NSAIDs) can prolong bleeding time and would not be prescribed for the child.

A child with a diagnosis of sickle cell disease is being admitted for the treatment of vaso-occlusive crisis. The nurse prepares for the admission anticipating which prescription for the child? 1. NPO status 2. Meperidine for pain 3. Intravenous fluids 4. Intubation to administer oxygen

3. 1. NPO status 2. Meperidine for pain 3. Intravenous fluids 4. Intubation to administer oxygen

The pediatric nurse assists the health care provider in performing a lumbar puncture on a 3-year-old child with leukemia and suspected central nervous system metastasis. The nurse should place the child in which position for this procedure? 1. Lithotomy position 2. Modified Sims' position 3. Lateral recumbent, knees flexed to the abdomen and the head bent, chin down 4. Prone, with the knees flexed to the abdomen and the head bent, the chin resting on the chest

3. A lateral recumbent position, with the knees flexed to the abdomen and the head bent with the chin resting on the chest, is assumed for a lumbar puncture. This position separates the spinal processes and facilitates needle insertion into the subarachnoid space. The remaining options are incorrect positions.

The pediatric nurse clinician is discussing the pathophysiology related to childhood leukemia with a class of nursing students. Which statement made by a nursing student indicates a need for further teaching of the pathophysiology of this disease? 1. The platelet count is decreased. 2. Red blood cell production is affected. 3. Reed-Sternberg cells are found on biopsy. 4. Normal bone marrow is replaced by blast cells.

3. In leukemia, normal bone marrow is replaced by malignant blast cells. As the blast cells take over the bone marrow, eventually red blood cell and platelet production is affected, and the child becomes anemic and thrombocytopenic. The Reed-Sternberg cell is found in Hodgkin's disease.

A child arrives at the emergency department with a nosebleed. On assessment, the nurse is told by the mother that the nosebleed began suddenly and for no apparent reason. What is the initial nursing action? 1. Insert nasal packing. 2. Prepare a nasal balloon for insertion. 3. Ask the child to sit down and lean forward, and apply pressure to the nose. 4. Place the child in a semi Fowler's position, and apply ice packs to the nose.

3. The initial nursing action for a child with a nosebleed is to have him or her sit down, ask the child to lean forward, and apply pressure to the nose for 5 to 10 minutes. Ice or cool compresses may also be applied to the nose and face. Placing the child in semi Fowler's position would cause swallowing of blood. Inserting nasal packing and preparing a nasal balloon are not appropriate initial interventions. A nasal packing or nasal balloon may be used if conservative measures fail.

A child is seen in the health care clinic for complaints of fever. On data collection, the nurse notes that the child is pale, tachycardic, and has petechiae. Aplastic anemia is suspected. The nurse should prepare the child to obtain which specimen that will confirm the diagnosis? 1. Platelet count 2. Granulocyte count 3. Red blood cell count 4. Bone marrow biopsy

4. Although the diagnosis of aplastic anemia may be suspected from the child's history and from the results of a complete blood count, a bone marrow biopsy must be performed to confirm the diagnosis.

A nurse receives a client that came by ambulance. The nurse thinks this client is experiencing pernicious anemia. What sign or symptom would suggest this? 1. Fruity breath 2. Halitosis 3. Strawberry red tongue 4. Red-beefy tongue

4. Clients in DKA often have fruity odor on their breath. Clients with red beefy tongues often have pernicious anemia. Clients with a strawberry red tongue often have kawasaki's syndrome. Clients with halitosis probably need to brush their teeth, but sometimes they can have tonsilloliths causing the bad breath.

A child is scheduled for allogeneic bone marrow transplantation (BMT). The parent of the child asks the nurse about the procedure. The nurse should provide which description about the BMT? 1. Aspiration of bone marrow from the child 2. Obtaining bone marrow from the child's twin 3. Obtaining bovine (cow) bone marrow and administering it to the child 4. Obtaining bone marrow from a donor who matches the child's tissue type

4. In allogeneic BMT, a donor who matches the child's tissue type is found. That bone marrow is then given to the child. In autologous BMT, the child undergoes general anesthesia for aspiration of his or her bone marrow, which is then processed in the laboratory and frozen until that marrow needs to be infused back into the child. Syngeneic BMT is done when the child has an identical twin. Administering bovine bone marrow to the child is not used in BMT.

Oral iron supplements are prescribed for a 6-year-old child with iron deficiency anemia. Which beverage is the best option to recommend with iron administration? 1. Milk 2. Water 3. Apple juice 4. Orange juice

4. Vitamin C (ascorbic acid) increases the absorption of iron by the body. The mother should be instructed to administer the medication with a citrus fruit or juice high in vitamin C. From the options presented, the correct option is the only one that identifies the food highest in vitamin C.

The mother of a 4-year-old child tells the pediatric nurse that the child's abdomen seems to be swollen. During further assessment, the mother tells the nurse that the child is eating well and that the activity level of the child is unchanged. The nurse, suspecting the possibility of Wilms' tumor, should avoid which during the physical assessment? 1. Palpating the abdomen for a mass 2. Assessing the urine for the presence of hematuria 3. Monitoring the temperature for the presence of fever 4. Monitoring the blood pressure for the presence of hypertension

1. Wilms' tumor is the most common intraabdominal and kidney tumor of childhood. If Wilms' tumor is suspected, the tumor mass should not be palpated by the nurse. Excessive manipulation can cause seeding of the tumor and spread of the cancerous cells. Hematuria, fever, and hypertension are clinical manifestations associated with Wilms' tumor.

A child presents to the ER after falling down the stairs and getting a cut on their knee that won't stop bleeding. The child states, "I always bleed a lot because I am missing a clotting factor." Which of the following conditions does this client likely have? 1. Hemophilia 2. Idiopathic Thrombocytopenic Purpura 3. Wiskott-Aldrich syndrome 4. Disseminated Intravascular Coagulation

1. Wiskott-Aldrich Syndrome is a disorder of the platelets where they are very small and limited in number causing prolonged bleeding. Hemophilia is a disorder where the blood is missing certain clotting factors and clotting is abnormal. Disseminated Intravascular Coagulation is occurs because the activation of the clotting cascasde causes mini clots to form all throughout the vasculature of the body. Idiopathic Thrombocytopenic Purpura is an autoimmune disorder where platelets are destroyed and the client is unable to clot. The client will bruise easily.

A nurse is caring for a patient with a history of acute myelogenous leukemia. Which actions of the following is a true statement regarding neutropenia and the complete blood cell count? Select all that apply. 1. Neutrophils ingest foreign pathogens and debris. 2. Monocytes are the immature form of neutrophils. 3. Acute infection causes a left shift, which is an increase in immature neutrophils. 4. Neutrophils are the first line of defense in infection. 5. Neutrophil levels should increase during times of infection.

1.2.3.4 Neutrophils are a type of white blood cell that are responsible for protecting the body by upholding the immune system. Immature neutrophils are known as bands and an increase in bands during infection is called a left shift. Neutrophils are normally the first line of defense in the body when infection occurs.

The nurse is conducting staff in-service training on von Willebrand's disease. Which should the nurse include as characteristics of von Willebrand's disease? Select all that apply. 1. Easy bruising occurs. 2. Gum bleeding occurs. 3. It is a hereditary bleeding disorder. 4. Treatment and care are similar to that for hemophilia. 5. It is characterized by extremely high creatinine levels. 6. The disorder causes platelets to adhere to damaged endothelium.

1.2.3.4.6. von Willebrand's disease is a hereditary bleeding disorder characterized by a deficiency of or a defect in a protein termed von Willebrand factor. The disorder causes platelets to adhere to damaged endothelium. It is characterized by an increased tendency to bleed from mucous membranes. Assessment findings include epistaxis, gum bleeding, easy bruising, and excessive menstrual bleeding. An elevated creatinine level is not associated with this disorder.

A client is brought into the healthcare clinic after suffering a laceration that caused severe bleeding. The nurse should assess for which signs or symptoms that would indicate anemia? Select all that apply. 1. Weakness and dizziness 2. Flushed skin 3. Fatigues easily 4. Cold hands and feet 5. Bradycardia

1.3.4. "Cold hands and feet", "Fatigues easily", and "Weakness and dizziness" are correct. Anemia can develop with hemorrhage if the client loses enough blood to impact hemoglobin levels. Signs and symptoms of anemia include cool extremities, weakness, and dizziness, and easily fatigued. "Flushed skin" is incorrect. A client with anemia would have pale skin, not flushed. "Bradycardia" is incorrect, because anemia is often accompanied by tachycardia, not bradycardia.

You are observing a new nurse assess a 7 year old male with nephroblastoma. Which of the following interventions is contraindicated? 1. Lung auscultation 2. Abdominal palpation 3. Carotid pulse palpation 4. Peripheral pulse palpation

2. Abdominal palpation is contraindicated with nephroblastoma, as it puts additional pressure on the tumor. All other interventions are not contraindicated.

A child is brought into the emergency department with severe injuries. The physician orders a transfusion of one unit of whole blood to be administered immediately. The nurse has completed a rapid assessment of the child but there are no laboratory results available to know the child's blood type. Which of the following actions of the nurse is most appropriate? 1. Administer oxygen and fluids until the laboratory results have returned 2. Contact the blood bank and request one unit of 'O' Rh-negative blood for the child 3. Contact the laboratory and request a cross-link between the lab outcomes and the blood type 4. Ask the physician if he ordered a type and crossmatch for the child

2. "Contact the blood bank and request one unit of 'O' Rh-negative blood for the child" is correct. When a patient requires a blood transfusion, the providers must send a sample of his blood for a type and crossmatch to ensure that he receives a matched blood product. In an emergency situation, however, the providers may transfuse 'O' Rh-negative blood without first checking the patient's type or performing a crossmatch, because a delay in this situation would do more harm than an immediate transfusion. "Ask the physician if he ordered a type and crossmatch for the child" is incorrect because this emergent situation requires the nurse to act immediately to get the blood product in the patient as safely and as soon as possible. "Administer oxygen and fluids until the laboratory results have returned" is incorrect because this indicates a delay in a life-saving treatment. The nurse should contact the blood bank for the 'O' negative blood as soon as possible. "Contact the laboratory and request a cross-link between the lab outcomes and the blood type" is incorrect. A type and crossmatch was not done in this situation, so any information obtained by the lab is not useful to match the blood product. The universal donor blood, type 'O' negative, should be given.

Which best describes a normal hemoglobin level for a 4-year-old child? 1. 20 g/dL 2. 12 g/dL 3. 18 g/dL 4. 16 g/dL

2. "12 g/dL" is correct. Hemoglobin concentration indicates the amount of oxygen-carrying hemoglobin molecules in the red blood cells. The normal level varies between gender and age for different clients. A normal hemoglobin level for a 4-year-old child averages 12.5 g/dL. "20 g/dL", "18 g/dL" and "16 g/dL" are all incorrect. These values are high and outside the normal range for hemoglobin for a four year old.

A nurse is caring for a four-year-old child who has severe anemia. Which of the following considerations must be followed when the nurse administers a dose of IM iron dextran to this child? 1. The medication will stain the child's teeth if it is given orally 2. If given intramuscularly, the medication should be given using the Z-track method 3. Iron dextran should never be given to a child younger than age 10 4. The medication is only available as an IV dose

2. "If given intramuscularly, the medication should be given using the Z-track method" is correct. Iron dextran is a preparation used in the treatment of severe anemia. It may be used in an adult or a pediatric patient but should not be given to a child who is younger than 4 months. The drug is often given when other methods of treatment have failed. When giving iron dextran intramuscularly, the nurse should inject it into a large muscle, using the Z-track method. This is to avoid leakage of the medication, which can cause staining in muscle tissue. "The medication will stain the child's teeth if it is given orally" is incorrect because the medicine is not available as an oral dose. The medication can stain muscle tissue if given intramuscularly. "The medication is only available as an IV dose" is incorrect because this medication is also available as an IM dose. "Iron dextran should never be given to a child younger than age 10" is incorrect because this medication can be given to infants as young as four months old.

A nurse is working on part of a research team that is developing medications for sickle cell anemia. The nurse is working with a 10-year-old child who would be a candidate for the research. When the nurse asks the child and her parents about the research, the child does not want to participate, but the parents say that it is okay. Which of the following is an accurate response in this situation? 1. Have the physician discuss the situation with the child and then ask for consent 2. Tell the child that she does not have to participate and let it go 3. Ask the parents to talk to the child and try to change her mind 4. Have the parents tell the child that she must participate, since they say so

2. There are certain situations in which children are needed for important medical research, however, children are considered to be a vulnerable population when participating because they do not always understand the implications. If the provider has explained the research to the child and she is old enough to understand what it means to participate, the child does not have to be a participant in the research if she truly does not want to, even if the parents give permission for it. If the child is unwilling to comply, the provider should let it go and avoid pushing or changing the family's mind.

The nursing student is presenting a clinical conference and discusses the cause of β-thalassemia. The nursing student informs the group that a child at greatest risk of developing this disorder is which of these? 1. A child of Mexican descent 2. A child of Mediterranean descent 3. A child whose intake of iron is extremely poor 4. A breast-fed child of a mother with chronic anemia

2. β-Thalassemia is an autosomal recessive disorder characterized by the reduced production of 1 of the globin chains in the synthesis of hemoglobin (both parents must be carriers to produce a child with β-thalassemia major). This disorder is found primarily in individuals of Mediterranean descent. Options 1, 3, and 4 are incorrect.

Which specific nursing interventions are implemented in the care of a child with leukemia who is at risk for infection? Select all that apply. 1. Maintain the child in a semiprivate room. 2. Reduce exposure to environmental organisms. 3. Use strict aseptic technique for all procedures. 4. Ensure that anyone entering the child's room wears a mask. 5. Apply firm pressure to a needle-stick area for at least 10 minutes.

2.3.4 Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia). A common complication of treatment for leukemia is overwhelming infection secondary to neutropenia. Measures to prevent infection include the use of a private room, strict aseptic technique, restriction of visitors and health care personnel with active infection, strict hand washing, ensuring that anyone entering the child's room wears a mask, and reducing exposure to environmental organisms by eliminating raw fruits and vegetables from the diet and fresh flowers from the child's room and by not leaving standing water in the child's room. Applying firm pressure to a needle-stick area for at least 10 minutes is a measure to prevent bleeding.

A client has been diagnosed with aplastic anemia. What do you tell the client in the way of education? Select all that apply. 1. The cause can be related to a loss of intrinsic factor 2. Chemical exposure can cause it 3. The treatment involves giving iron supplementation 4. It is most often immune-mediated 5. It can be caused by radiation

2.4.5. Aplastic anemia can be immune-mediated, caused by irradiation or chemical exposure. The only real treatment is transfusion. It often is coexistent with leukopenia. Iron supplementation does not help this condition.

A 6-year-old child with leukemia is hospitalized and is receiving combination chemotherapy. Laboratory results indicate that the child is neutropenic, and protective isolation procedures are initiated. The grandmother of the child visits and brings a fresh bouquet of flowers picked from her garden, and asks the nurse for a vase for the flowers. Which response should the nurse provide to the grandmother? 1. "I have a vase in the utility room, and I will get it for you." 2. "I will get the vase and wash it well before you put the flowers in it." 3. "The flowers from your garden are beautiful, but should not be placed in the child's room at this time." 4. "When you bring the flowers into the room, place them on the bedside stand as far away from the child as possible."

3. Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia). For a hospitalized neutropenic child, flowers or plants should not be kept in the room because standing water and damp soil harbor Aspergillus and Pseudomonas aeruginosa, to which the child is susceptible. In addition, fresh fruits and vegetables harbor molds and should be avoided until the white blood cell count increases.

When providing end-of-life care to a 4-year-old child who is dying of cancer, which of the following interventions would be utilized to ensure that the nurse is providing adequate pain control? 1. Ensure the pain medication is available as an oral liquid instead of IV preparation 2. Ask for feedback from the parents about the effectiveness of pain control 3. Encourage the child to talk about his feelings 4. Ask the provider to order a patient-controlled analgesia

3. "Ask for feedback from the parents about the effectiveness of pain control" is correct. A child who is in pain may or may not demonstrate it in the same manner as adults. It is important for the nurse who is caring for a child in pain to look for signs that demonstrate pain and to talk with the child's caregivers who know him best. In this situation, the parents are a good resource for understanding how their child demonstrates pain in his own unique way. They would most likely be able to tell if the pain medication is being effective or if the child is still in pain. "Ensure the pain medication is available as an oral liquid instead of IV preparation" is incorrect. Depending on the situation, the child may not be able to take medications orally. "Encourage the child to talk about his feelings" is incorrect. Talking about feelings does not decrease physical pain in a 4-year-old. "Ask the provider to order a patient-controlled analgesia" is incorrect. A child who is six years old may be able to use patient-controlled analgesia independently, but not a child younger than six years of age.

The nurse is collecting data on a 12-month-old child with iron deficiency anemia. Which finding should the nurse expect to note in this child? 1. Cyanosis 2. Bronze skin 3. Tachycardia 4. Hyperactivity

3. Clinical manifestations of iron deficiency anemia will vary with the degree of anemia but usually include extreme pallor with a porcelain-like skin, tachycardia, lethargy, and irritability.

Your patient has leukemia. What is a major cause of death for patients whose immune system is suppressed? 1. Thombocytopenia 2. Stroke 3. Infection 4. Hypovolemia

3. Infection is a major concern of all immunosuppressed patients. While a patient can become hypovolemic, develop a stroke, or have thrombocytopenia, it's not what immunosuppressed patients typically die from. When you think immunosuppresion, always maintain concern for infection as one of the main priorities.

The nurse is reviewing the record of a 10-year-old child suspected of having Hodgkin's disease. Which characteristic manifestation should the nurse anticipate to be documented in the assessment notes? 1. Fever 2. Malaise 3. Painful lymph nodes in the supraclavicular area 4. Painless and movable lymph nodes in the cervical area

4. Clinical manifestations specifically associated with Hodgkin's disease include painless, firm, and movable adenopathy in the cervical and supraclavicular areas. Hepatosplenomegaly is also noted. Although anorexia, weight loss, fever, and malaise are associated with Hodgkin's disease, these manifestations are vague and can be seen in many disorders.

The pediatric nurse educator is providing a teaching session to nursing staff about hemophilia. Which statement should the nurse educator include? 1. "Acetylsalicylic acid is given for pain control." 2. "Hemarthrosis is the result of synovial cavity aspiration." 3. "Total joint rest along with ice pack application continues for 72 hours after factor VIII is administered." 4. "Affected prepubescent girls should be counseled concerning menorrhagia, which may be life-threatening."

4. The female offspring of an affected male and a carrier female is at risk for hemorrhage once puberty is attained and menstrual cycles begin, and depending on the severity of the hemophilia, a hysterectomy or ablation may be performed. The remaining options are incorrect statements. Aspirin is not routinely given to young children and would not be given to a child with a bleeding disorder because of its effects on platelet aggregation. Hemarthrosis is the result of bleeding into the joint cavity, not of aspiration. Seventy-two hours is too long for the joint to be rested because maintenance of mobility is a primary concern once the bleeding episode has been arrested.

The nurse provides instructions to the mother of a child with sickle cell disease. Which statement by the mother indicates a need for further teaching? 1. "I need to be sure that my child has adequate rest periods." 2. "I will take my child's temperature and watch for a fever." 3. "I need to encourage my child to drink large amounts of fluids." 4. "I know my child must spend as much time as possible in the sun."

4. The nurse should instruct the mother to encourage fluid intake 1.5 to 2 times the daily requirements. Adequate rest periods should be provided, and the child should not be exposed to cold or heat stress. The mother should be taught how to take the child's body temperature and how to use a thermometer properly. Sources of infection should be avoided, as should prolonged exposure to the sun.

The nurse is caring for a child with hemophilia and is reviewing the results that were sent from the laboratory. Which result should the nurse expect in this child? 1. Shortened prothrombin time (PT) 2. Prolonged PT 3. Shortened partial thromboplastin time (PTT) 4. Prolonged PTT

4. PTT measures the activity of thromboplastin, which is dependent on intrinsic factors. In hemophilia, the intrinsic clotting factor VIII (antihemophilic factor) is deficient, resulting in a prolonged PTT. The results in the remaining options are incorrect. The PT may not necessarily be affected in this disorder.

The client has hemolytic anemia. You explain to a student nurse that the causes of hemolytic anemia include the following. Select all that apply. 1. Prosthetic heart valve 2. Antibodies to red blood cells 3. Low folate intake 4. Low intrinsic factor 5. Transfusion reaction

1.2.5. Hemolytic anemia can be caused by antibodies to red blood cells, mechanical loss from a prosthetic heart valve, sequestration by the liver or spleen, or a transfusion reaction.

The client requires treatment for sickle cell disease. Treatments for sickle cell disease include the following. Select all that apply. 1. Folic acid 2. Desferrioxamine 3. Steroids 4. Penicillin 5. Vitamin B12

1.3.4. Penicillin is to protect the person against infections because of splenic dysfunction, folic acid is used to build up stores of folate, and Desferrioxamine is used to chelate iron and decrease iron overload.

A 6-year-old child has just been diagnosed with localized Hodgkin's disease, and chemotherapy is planned to begin immediately. The mother of the child asks the nurse why radiation therapy was not prescribed as a part of the treatment. What is the nurse's best response? 1. "It's very costly, and chemotherapy works just as well." 2. "I'm not sure. I'll discuss it with the health care provider." 3. "Sometimes age has to do with the decision for radiation therapy." 4. "The health care provider would prefer that you discuss treatment options with the oncologist."

3. Radiation therapy is usually delayed until a child is 8 years old, whenever possible, to prevent retardation of bone growth and soft tissue development. Options 1, 2, and 4 are inappropriate responses to the mother and place the mother's question on hold.