Peds Exam 2: Immune and onco

The nurse is caring for a child and notes periorbital edema on the left eye with urticaria. Which action by the nurse is priority? Administer a corticosteroid. Ask if the child has allergies. Evaluate fluid volume status. Assess lung sounds bilaterally.

D

The nurse is monitoring the CD4 count of an infant who has contracted HIV from the mother in utero. The nurse is concerned that treatment with antiretroviral therapy is not effective when noting which CD4 level? A. 1900/mm3 B. 1700/mm3 C. 1500/mm3 D. 1300/mm3

D

A 10-year-old who is receiving chemotherapy has received ondansetron before this therapy session. About an hour later, the child tells the nurse that his mouth feels really dry. The child has urinated several times and his skin turgor is normal. Which response by the nurse would be most appropriate? "The drug you got to help with the nausea can cause dry mouth." "Let me increase your intravenous fluids." "You might be having a severe allergic reaction. Are you itchy?" "This indicates an infection. We need to start antibiotics."

A

The nurse identifies the nursing diagnosis of risk for infection related to chemotherapy-induced immunosuppression. What would the nurse include in the teaching plan for the child and parents about reducing the child's risk? Select all that apply. A. Having the child sleep in a single bed and room B Encouraging frequent, thorough handwashing C Providing a low-carbohydrate, low-protein diet D Encouraging frequent close contact with numerous visitors E Cheering up the environment with fresh flowers and plants

A B

A nursing instructor teaching a class about immunity asks the students to identify the organs of the immune system. Which would the nursing instructor want them to include? (Select all that apply. A. lymph nodes B bone marrow C thymus D liver E spleen F tonsils

A B C E F

A nurse is conducting a physical examination of a 12-year-old girl with suspected systemic lupus erythematosus (SLE). How would the nurse best interview the girl? "Do you notice any wheezing when you breathe or a runny nose?" "Do you have any shoulder pain or abdominal tenderness?" "Have you noticed any new bruising or different color patterns on your skin?" "Have you noticed any hair loss or redness on your face?"

D

A 6-month-old girl is seen with retinoblastoma. When taking a health history from her father, which symptom would you expect him to report he has noticed? The infant always keeps her eyes tightly closed. He has noticed one pupil appears white. C. His daughter tugs and pulls at one ear. D. His daughter's eye appears to be protruding.

B

A young client is admitted to the hospital directly from the clinic. The physician suspects a problem with the child's immune system. What test does the nurse anticipate the physician will order for this client? Urine analysis Blood analysis EKG X-ray

B

A preschooler who received chemotherapy in the pediatric oncology outpatient department 1 week ago now has a temperature of 101.5°F (38.6°C). Which is the most appropriate response by the nurse? A Tell the parent to administer acetaminophen every 4 hours until the fever dissipates. B Ask whether any family members or other close associates are ill. C Have the parent bring the child to the pediatric oncology clinic as soon as possible. D Instruct the parent to immediately obtain and give the antibiotic that the oncologist will order.

C

A 7-year-old child is rushed into the emergency room after being stung by a yellow jacket. The child is nauseated and vomiting and is experiencing itching and swelling on the arm where stung. The is having trouble breathing. Which type of hypersensitivity response is the child experiencing? Type I: anaphylaxis Type II: cytotoxic response Type III: immune complex Type IV: cell-mediated hypersensitivity

A

An adolescent is recovering from surgery, radiation, and chemotherapy following a diagnosis of Ewing sarcoma. Which statement by the family indicates that reteaching is needed? "Our child is looking forward to playing football again." "We will remind our child to care for the skin following radiation." "Our child's friends shaved their heads in solidarity to show their support." "We will watch for signs of infection and report it to our health care provider."

A

Antiemetics are ordered to control nausea and vomiting in the child undergoing chemotherapy. How can the nurse most effectively use these medications? A Administer the antiemetic before starting chemotherapy B Provide the antiemetic as needed (PRN) when nausea and vomiting are reported C Use the antiemetic after it is clear that nonpharmacologic methods are not effective D Start the antiemetic on a scheduled basis when the chemotherapy begins to cause nausea

A

The nurse is assessing a 10-year-old girl with acute lymphoblastic leukemia. What information would lead the nurse to suspect that the cancer has infiltrated the central nervous system? Child reports of facial palsy and vision problems Observing petechiae, purpura, or unusual bruising Noting adventitious breath sounds during auscultation Palpation of abdomen reveals enlarged liver and spleen

A

The nurse is preparing to post a sign above the crib of an infant with a Wilms tumor. Which statement should the nurse post immediately? "Do not palpate abdomen." "No intramuscular injections." "No milk or milk products allowed." "No blood sampling in lower extremities."

A

The nurse is reviewing the immunization schedule with the parent of a child who is HIV positive. What information should the nurse provide? Select all that apply. A Pneumococcal vaccination can be given. B The child should receive live vaccines only. C The human papillomavirus vaccine should not be given. D The varicella vaccine should not be given if the child is symptomatic. E If the CD4 count is low, the measles, mumps, and rubella vaccine should not be given.

ADE

Which nursing diagnosis will the nurse select as appropriate for the child with atopic dermatitis? Select all that apply A Impaired skin integrity related to skin barrier function B Delayed growth related to chronicity of immune disorder C Ineffective breathing pattern related to allergic bronchospasm D Anxiety related to continuing or uncontrolled allergic response E Powerlessness related to difficulty determining cause of allergy

ADE

A 6-year-old is dealing with the death of a sibling. Which action should the nurse suggest to the family to best support the child with the grieving process? A Having the child stay with a family friend instead of attending the funeral B Assisting the child in drawing a picture to be placed in the sibling's casket C Having the sibling stand in the receiving line with the parents at the funeral home D Discouraging the child from interacting with family and friends while they express their sympathy

B

The nurse is instructing parents on how atopic disorders affect the child. For which disorder would the nurse provide information and counseling? Select all that apply. A Serum sickness B Allergic rhinitis C. Asthma D Eczema E Hay fever

BCDE

A child is receiving chemotherapy and develops stomatitis. The nurse identifies a nursing diagnosis of impaired oral mucous membranes related to the effects of chemotherapy. What instructions would the nurse include in the child's plan of care? Select all that apply. A Vigorously rub the child's gums with gauze to clean them. B Provide various soft and bland foods to minimize further irritation. C Have the child rinse the mouth with lukewarm water three times a day. D Give the child acidic foods (e.g., orange juice) to cleanse the mouth. E Apply a lip balm or petroleum jelly to prevent cracking.

BCE

The client has been prescribed antihistamines and a round of corticosteroids to treat an allergic reaction to an unknown food source. Which statement by the client indicates he understands the allergic condition and medication regimen? A "The antihistamine will help the nasal swelling I am having." B "Corticosteroids help the inflammation that goes along with an allergy." C "I can stop taking my steroids as soon as I feel better in a couple of days." D "I may have to undergo intradermal testing to determine what I am allergic to." E "Once we figure out what I am allergic to, it is important for me to avoid that allergen."

BDE

A 16-year-old child suffering from alopecia related to chemotherapy treatment is refusing to let friends visit. Which action by the nurse is most appropriate? Respect the child's wishes and document refusal Have the parents explain the importance of letting friends visit Provide opportunities for the child to discuss his or her body image changes Allow friends to visit because socialization is important for adolescents

C

The clinic nurse reviews a 16-year-old client's chart (above) prior to entering the examination room for a routine check-up. Which data should concern the nurse most? Blood pressure Heart rate Temperature Body mass index (BMI)

D

A child receiving chemotherapy is experiencing significant reduction in red blood cells secondary to myelosuppression. Which agent would the nurse most likely expect to be ordered? Epoetin alfa Filgrastim Sargramostim Gamma interferon

A

A 9-year-old child with leukemia is scheduled to undergo an allogenic hematopoietic stem cell transplant. When teaching the child and parents, what information would the nurse include? "We'll need to have a match to a donor." "The risk for rejection is much less with this type of transplant." "You won't need to receive the high doses of chemotherapy before the transplant." "You'll need to have an incision in your hip area to instill the cells."

A

A nurse is communicating with a family about palliative care. Which of the following would be the best approach to take? A Ask the family what they know, what they wish to know and be prepared to repeat the information you give to them several times B Give the family as much information as possible to promote better decision-making C Provide information during a crisis when the parent's senses are heightened and memory is improved D Avoid pushing the family by asking too many questions.

A

Nursing students correctly label the group of cells whose job is to ingest, engulf, and neutralize pathogens as: macrophages. immunogens. immunoglobins. red blood cells.

A

Which nursing intervention is priority when caring for a child with HIV? Administer prescribed medications. Assist the child with daily activities. Assess pain after invasive procedures. Review laboratory CD4 counts daily.

A

A child receiving chemotherapy wants to have a large birthday party and invite all the classmates. When the parent asks the nurse about this, what is the nurse's best response? "That will be a good way to cheer your child up!" "It is better to avoid large groups right now." C. "What about taking your child to a movie instead?" D. "We can have the party here in the hospital play room."

B

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

B

An adolescent client has just been diagnosed with systemic lupus erythematosus (SLE). Following client education about the disease, which statement by the client demonstrates understanding of SLE? "SLE is a rheumatic disease that mostly affects my joints." "SLE is an autoimmune disorder that I will always have, with times of flare- ups and times of minimal to no symptoms." "If my SLE has been found early enough in the disease process, there is a good chance that medication can cure it." "SLE only affects my skin. It seldom causes problems in any other organs."

B

The nurse has completed an education session with parents of children diagnosed with food allergies. Which statement by a parent would indicate a need for additional education? "I will make sure my daughter always has her EpiPen® with her all the time." "If we need to use the EpiPen® we will need to notify her physician's office the next business day." C. "I have found a website that makes medical alert bracelets in my daughter's favorite color." D. "The grey part of the EpiPen® should never be removed until right before we use it."

B

The nurse is providing teaching about food substitutions when cooking for the child with an allergy to eggs. Which response indicates a need for further teaching? "I must not feed my child eggs in any form." "I can use the egg white when baking, but not the yolk." "1 tsp yeast and 1/4 cups warm water is a substitute in baked goods." "1.5 Tbsp each water and oil plus 1 tsp baking powder equals one egg in a recipe."

B

A school nurse is developing educational materials for a school health fair that will be attended by 16-year-old students. Which information should the nurse include related to growth and development for this age group? A. Hair growth in the pubic area will begin. Breast enlargement in girls will slow or stop. Height and weight are close to that of an adult. Growth spurts are complete.

C

A child is to receive an oral corticosteroid as part of the treatment regimen for leukemia. After teaching the child and family about this drug, the nurse determines the need for additional teaching when they state: "We should administer the drug on an empty stomach." "We should check our son's urine for glucose." "He might develop a rounded face from this drug." D. "We will need to gradually decrease the dosage."

A

The nurse is preparing a discharge teaching plan for the parents of an 8-year-old girl with leukemia. Which instruction would be the priority? Calling the doctor if the child gets a sore throat Keeping a written copy of the treatment plan Writing down phone numbers and appointments Using acetaminophen if the child needs an analgesic

A

The child has a peanut allergy and accidentally ate food that contained peanuts. Which clinical manifestations of anaphylaxis should the nurse expect to find? Select all that apply. A The child's pulse is 52 beats per minute. B The child states that his tongue feels "too big" for his mouth. C The child has developed hives on his face and trunk. D The child states he feels like he might "throw up". E The child states that he feels like he might faint.

BCDE

The nurse is preparing an educational program for members of the office staff. The topic is the warning signs of primary immunodeficiency. What information should be included? Select all apply. A Two or more new episodes of acute otitis media in 1 year. B Two or more episodes of severe sinusitis in 1 year. C Failure to thrive in an infant. D Two or more serious infections such as sepsis. E History of infections requiring IV antibiotics to clear.

BCDE

A child with allergic rhinitis is prescribed a nasal antihistamine spray. When advising the parents about the use of the sprays, what should the nurse explain about the rebound phenomenon? It causes a permanent increase in nasal secretions. It causes reflux of gastric contents into the esophagus. It causes an increase in nasal secretions after an initial decrease. It causes a decrease in histamine release after an initial increase.

C

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

C

An adolescent has recently been diagnosed with epilepsy. To help the client adjust to the new diagnosis, the nurse must consider which characteristic of psychosocial development common to this age group? Desire to cultivate a close relationship with parents Decision-making process that is highly analytical Fear of being viewed as different by peer group Constant focus on consequences of actions

C

The adoptive parents of a child who is 7 years old and HIV positive are concerned about telling their child about his condition. What information can be provided by the nurse? A The child should not have information about their health provided at this age. B Children at this age should have full disclosure of their condition. C When providing health information to a child of this age it should be simplistic and at the child's level of understanding. D Once a child is apprised of their health concerns they do not normally experience any after affects.

C

The nurse realizes that the chemotherapy agents and radiation that a child is receiving are likely to irritate the bladder. What are the best measures that the nurse can take to diminish this risk? A Administer chemotherapy during sleep periods, including naps and overnight B Have the child wait to void until the bladder becomes full C Keep intravenous (IV) fluids running to maintain excellent hydration and frequent voids D Promote drinking of cranberry juice, making it an attractive oral fluid option

C

The nurse is caring for a pediatric client who has a compromised immune system. When reviewing laboratory results, which bone marrow component identifies a dysfunction in bone marrow production? Select all that apply. A Macrophages B Antigens C T lymphocytes D B lymphocytes E Haptens

CD