Peds Exam 4

the nurse is performing an assessment on a 10 yo child suspected to have Hodgkins disease. which assessment findings are specifically characteristic of this disease? select all a. abdominal pain b. fever and malaise c. anorexia and weight loss d. painful, enlarged inguinal lymph nodes e. painless, firm, and movable adenopathy in cervical area

a, e a. abdominal pain e. painless, firm, and movable adenopathy in cervical area specific CM include: painless firm movable adenopathy in cervical and supraclavicular areas and abdominal pain as a result of enlarged retroperitoneal nodes. hepatosplenomegaly is also noted. although fever, malaise, anorexia, and weight loss are seen in this disease, they are seen in many disorders.

The family and child have decided that hospice care best meets their needs during the terminal phase of illness. The nurse recognizes that the parents understand the principles of this care when they make which statement? a. "it will be good to be at home and care for our child" b. "what a relief it will be not to need any more medicines" c. "we are going to miss the support of the hospice team when our child dies" d. "we know that once hospice care starts we will not be able to return to the hospital if the care is difficult"

a. "it will be good to be at home and care for our child"

a child has returned to the PICU following a brain tumor resection. which nursing assessment takes priority? a. ICP b. skin integrity c. pain and discomfort d. mobility

a. ICP

The nurse analyzes the laboratory values of a child with leukemia who is receiving chemotherapy . The nurse notes that the platelet count is 20,000. Based on the laboratry result, which intervention will the nurse document in the plan of care? a. initiate bleeding precautions b. monitor closely for sx of infection c. monitor temp q4h d. initiate protective isolation precautions

a. initiate bleeding precautions normal platelets: 150,000-450,000

In teaching parents how to minimize or prevent bleeding episodes when the child is myelosuppressed, the nurse includes what information? a. meticulous mouth care is essential to avoid mucositis b. rectal temperatures are necessary to monitor for infection c. IM injections are preferred to IV d. platelet transfusions are given to maintain a count greater than 50,000/mm3

a. meticulous mouth care is essential to avoid mucositis

the mother of a 4yo child tells the pediatric nurse that the child's abdomen seems 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 or Wilms' tumor, should avoid which during the physical assessment? a. palpate abdomen for mass b. assess the urine for presence of hematuria c. monitoring the temp for presence of fever d. monitoring BP for HTN

a. palpate abdomen for mass

a 12 yo child has failed several courses of chemotherapy. an experimental drug is available that his parents want him to receive. he has told his parents and the oncologists that he is ready to die and does not want any more chemotherapy. the nurse recognizes that: a. parents and child both need support in the decision making b. 12 year olds are minors and cannot give consent or refuse treatments c. the oncologists will need to make the decision since the parents and child disagree d. the parents have the right and responsibility to make decisions for their children under age 18 years

a. parents and child both need support in the decision making

the nurse is precasting a new graduate nurse at an ambulatory pediatric hematology/oncology clinic. which of the following cardinal sx of cancer in children should the nurse make the new nurse aware of? select all a. sudden tendency to bruise easily b. transitory, generalized pain c. frequent headaches d. excessive, rapid wt gain e. gradual, steady fever f. unexplained loss of energy

a. sudden tendency to bruise easily c. frequent headaches f. unexplained loss of energy

in working with terminally ill children, the nurse knows that in which age group are perceptions of death intertwined with fantasy? a. toddler b. school-age c. preschool d. adolescent

a. toddler

the nurse is monitoring a 3yo child for sx of increased ICP after a craniotomy. the nurse plans to monitor for which early sx of increased ICP? a. vomiting b. bulging anterior fontanel c. increasing head circumference d. complaints of frontal headache

a. vomiting

which specific nursing interventions are implemented in the care of a child with leukemia who is at risk for infection? select all a. maintain the child in a semiprivate room b. reduce exposure to environmental organisms c. use strict aseptic technique for all procedures d. ensure that anyone entering the child's room wears a mask e. ally firm pressure to a needle stick area for at least 10 min

b, c, d b. reduce exposure to environmental organisms c. use strict aseptic technique for all procedures d. ensure that anyone entering the child's room wears a mask

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 further information? a. "The fever is the most common sign of this sarcoma" b. "The child does not experience pain at the primary tumor site" c. "Limping, if a weight bearing limb is affected, is a sx" d. "The sx of the disease in the early stage are almost always attributed to normal growing pains"

b. "The child does not experience pain at the primary tumor site"

A 3yo child is admitted with a low neutrophil count 10 days after chemo for ALL. Which roommate selection would be the most appropriate? a. 3yo w/ bronchiolitis b. 5yo w/ fractured femur c. 4yo w/ strep infection d. 3yo w/ hx of diarrhea

b. 5yo w/ fractured femur

a 4yo child is admitted to the hospital with abdominal pain. The mother reports that the child has been pale and excessively tired and is bruising easily. On physical exam, lymphadenopathy and hepatosplenomegaly are noted. diagnostic studies are being performed b/c ALL is suspected. the nurse determines that which lab result confirms the dx? a. LP showing no blast cells b. bone marrow biopsy showing blast cells c. platelet count of 350,000 d. WBC count 4,500

b. bone marrow biopsy showing blast cells increase in number of leukocytes, usually at immature stage in bone marrow. LP would be done to determine CNS involvement

a child is hospitalized with Ewings sarcoma. which assessment finding is consistent with this dx? a. SOB b. bone pain and swelling c. bloody diarrhea d. ataxia and falls

b. bone pain and swelling

which category best illustrates the consistent stress, pressure, and anxiety caused by caring for a chronically ill child? a. moral distress b. caregiver burden c. role confusion d. role strain

b. caregiver burden

Principles of palliative care that can be included in the care of children include: a. maintenance of curative therapy b. child and family as the unit of care c. focus on the spiritual issues the family faces d. extensive use of opiates to ensure total pain control

b. child and family as the unit of care

the nurse is caring for a child receiving chemo for leukemia. the childs granulocyte count is 600/mm3 and platelet count is 45,000/mm3. which of the following should the nurse recommend in terms of dental care for this child? a. rinsing mouth with water b. daily toothbrushing and flossing c. lemon glycerin swabs for cleansing d. wiping teeth with moistened gauze or toothbrush

b. daily toothbrushing and flossing

one of the first priorities for a nurse caring for a patient with anemia should include: a. hydration at 2 times fluid maintenance b. implement energy conservation interventions c. be sure there is an order for PT to help child regain mobility and energy

b. implement energy conservation interventions

the nurse is monitoring a child or 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 interventions should the nurse perform immediately? a. reinforce the dressing b. notify the HCP c. document the findings and continue to monitor d. circle the area of drainage and continue to monitor

b. notify the HCP colorless drainage indicates CSF and should be reported immediately

which one of the following childhood cancers may demonstrate patterns of inheritance that suggest a familial basis? a. leukemia b. retinoblastoma c. rhabdomyosarcoma d. osteogenic sarcoma

b. retinoblastoma

the nurse is administering an IV chemo agent to the child with leukemia. the child suddenly begins to wheeze and have severe urticaria. which of the following is the most appropriate nursing action? a. recheck the rate of drug infusion b. stop drug infusion immediately c. observe child closely for next 10 min d. explain to child that this an expected side effect

b. stop drug infusion immediately urticaria= hives

the parents of a 5 yo with ALL are told their child is in remission and they want to stop chemo. which response by the nurse is most appropriate? a. "yes, we usually stop chemo as soon as remission is achieved" b. "there is no scientific evidence that favors continuing or stopping treatment" c. "if treatment is d/c, most children have a relapse within a short time" d. "Of course, the decision about treatments is entirely up to you as parents"

c. "if treatment is d/c, most children have a relapse within a short time" maintenance therapy to maintain remission for 2.5-3years

a child is admitted for allogenic bone marrow transplant. the nurse is aware that the donor marrow is coming from which source? a. a cadaver b. the child c. a sibling d. lab created

c. a sibling

the pediatric nurse working in an acute inpatient unit understands that a DNR order includes which measure? a. administering radiation therapy in an attempt to eradicate the disease b. administering antibiotic therapy as scheduled by the physician c. administering no life saving measures in the event of respiratory arrest d. administering feeding via oral gastric tube for artificial nutrition

c. administering no life saving measures in the event of respiratory arrest

a family with a chronically ill child r responds to changes in the child's condition with alternating periods of grief and denial. when documenting the behavior, which description is most appropriate? a. maladaptive grief b. caregiver role strain c. chronic sorrow d. impaired coping

c. chronic sorrow

a 4yo's sibling has died. even though she was told her sibling is dead, the child keeps asking when she will come back. the pediatric nurse knows this is an example of which item? a. state of denial b. memory loss caused by stress c. developmental approach to death d. severe psychopathology

c. developmental approach to death

a school age child is diagnosed with a life-threatening illness. the parents want to protect their child form knowing the seriousness of the illness. the nurse should explain that: a. this attitude is helpful to give parents time to cope b. this will help the child cope effectively by denial c. terminally ill children know when they are seriously ill d. terminally ill children usually choose not to discuss the seriousness of their illness

c. terminally ill children know when they are seriously ill

the pediatric nurse provides teaching to the parents of a 6 yo who is being d/c after chemo. which instruction by the nurse is most appropriate? a. "Do not allow your child to play with any other children for a few days" b. "Be sure to encourage your child to. brush his teeth vigorously every day" c. "If your child feels warm, be sure to take your temperature rectally" d. "Bring your child to the ED for a fever of 101.2F"

d. "Bring your child to the ED for a fever of 101.2F"

the nurse is d/c a child who has just received chemotherapy. which of the following statements made by the child's parents indicates a need for additional teaching? a. "I will inspect the skin often for any lesions" b. "I will do mouth care daily and monitor for mouth sores" c. "I will wash my hands prior to caring for my child" d. "I will take a rectal temp daily and report a temp greater than 101F immediately to HCP"

d. "I will take a rectal temp daily and report a temp greater than 101F immediately to HCP" rectal temp unnecessary

the nurse reads in a childs chart that lab studies were positive for Reed-Sternberg cells. which disease process does the nurse associate with this finding? a. ALL b. Rhabdomyosarcoma c. glial cell brain tumor d. Hodgkins disease

d. Hodgkins disease

which of the following immunizations should not be given to a child receiving chemotherapy for cancer? a. tetanus vaccine b. inactivated polio vaccine c. diphtheria, pertussis, tetanus d. MMR

d. MMR

at what age do most children have an adult concept of death as being inevitable and irreversible? a. 4-5years b. 5-6 years c. 8-9 years d. adolescent

d. adolescent

the nurse explains to parents of a child undergoing an oncological work-up that the exact cause of most cancers is unknown, but some factors are known to be involved. which of the following is inconsistent with this understanding? a. viruses b. genetics c. environmental exposures d. bacterial infections

d. bacterial infections unsure why, from book w/ no explanation

a dx of Hodgkin's disease is suspected in a 12yo child. several dx studies are performed to determine the presence of this disease. which dx test result will confirm Hodgkin's disease? a. elevated vanillylmandelic acid urinary levels b. the presence of blast cells in the bone marrow c. the presence of epstein-barr virus in the blood d. the presence of Reed-Sternberg cells in the lymph nodes

d. the presence of Reed-Sternberg cells in the lymph nodes

a 5yo's mother died. now when anyone mentions her name, the child runs from the room screaming "mommy, where are you? why won't you come back?" otherwise the child refuses to talk about his mother at all. which intervention would be effective in helping the child explore his grief? a. talking to him about his feelings at bedtime b. encouraging him to write down his feelings c. telling him that his mother has gone away on a trip d. using creative activities such as drawing or play therapy

d. using creative activities such as drawing or play therapy

The nurse is caring for a child with leukemia. The nurse should be aware that children being treated for leukemia may experience which of the following complications? Select all that apply. 1. Anemia. 2. Infection. 3. Bleeding tendencies. 4. Bone deformities. 5. Polycythemia.

1, 2, 3 rationale for each: 1. Anemia is caused by decreased production of red blood cells. 2. Infection risk in leukemia is secondary to the neutropenia. 3. Bleeding tendencies are from decreased platelet production. 4. There are no bone deformities with leukemia, but there is bone pain from the proliferation of cells in the bone marrow. 5. Polycythemia is an increase in red blood cells.

Which of the following can be a manifestation of leukemia in a child? Select all that apply. 1. Leg pain. 2. Fever. 3. Excessive weight gain. 4. Bruising. 5. Enlarged lymph nodes.

1, 2, 4, 5 rationale for each: 1. The proliferation of cells in the bone marrow can cause leg pain. 2. Fever is a result of the neutropenia. 3. There is usually a decrease in weight because the child will feel sick and not as hungry. 4. A decrease in platelets causes the bruising. 5. The lymph nodes are enlarged by the infiltration of leukemic cells.

A nurse is caring for a 15-year-old who has just been diagnosed with non-Hodgkin lymphoma. Which of the following should the nurse include in teaching the parents about this lymphoma? Select all that apply. 1. The malignancy originates in the lymphoid system. 2. The presence of Reed-Sternberg cells in the biopsy is considered diagnostic. 3. Mediastinal involvement is typical. 4. The disease is diffuse rather than nodular. 5. Treatment includes chemotherapy and radiation.

1, 3, 4, 5. rationale for each: 1. Non-Hodgkin disease originates in the lymphoid system. 2. Reed-Sternberg cells are diagnostic for Hodgkin disease and are not seen in non-Hodgkin lymphoma. Reed-Sternberg cells arise from "B" cells and are large, multinucleated cells. 3. Mediastinal involvement is typical. 4. The disease is diffuse rather than nodular. 5. Treatment includes chemotherapy and radiation.

The parent of a 4-year-old brings the child to the clinic and tells the nurse the child's abdomen is distended. After a complete examination, a diagnosis of Wilms tumor is suspected. Which of the following is most important when doing a physical examination on this child? 1. Avoid palpation of the abdomen. 2. Assess the urine for the presence of blood. 3. Monitor vital signs, especially the blood pressure. 4. Obtain an accurate height and weight.

1. Avoid palpation of the abdomen.

The parent of a teen with a diagnosis of Hodgkin disease asks what the child's prognosis will be with treatment. What information should the nurse give to the parent and child? 1. Clinical staging of Hodgkin disease will determine the treatment; long-term survival for all stages of Hodgkin disease is excellent. 2. There is a considerably better prognosis if the client is diagnosed early and is less than 5 years of age. 3. The prognosis for Hodgkin disease depends on the type of chemotherapy. 4. The only way to obtain a good prognosis is by chemotherapy and bone marrow transplant.

1. Clinical staging of Hodgkin disease will determine the treatment; long-term survival for all stages of Hodgkin disease is excellent. rationale for each: 1. Long-term survival for all stages of Hodgkin disease is excellent. Early-stage disease can have a survival rate greater than 90%, with advanced stages having rates between 65% and 75%. 2. Hodgkin disease mostly affects adolescents. 3. The treatment consists of chemotherapy and often radiation therapy and does not predict prognosis. 4. Bone marrow transplant is not always necessary with the treatment of Hodgkin disease and will most likely worsen the prognosis.

A child diagnosed with leukemia is receiving allopurinol (Zyloprim) as part of the treatment plan. The parents ask why their child is receiving this medication. What information about the medication should the nurse provide? 1. Helps reduce the uric acid level caused by cell destruction. 2. Helps make the chemotherapy more effective. 3. Helps reduce the nausea and vomiting associated with chemotherapy. 4. Helps decrease pain in the bone marrow.

1. Helps reduce the uric acid level caused by cell destruction. (has to do with tumor lysis syndrome !!)

Which of the following confirms a diagnosis of Hodgkin disease in a 15-year-old? 1. Reed-Sternberg cells in the lymph nodes. 2. Blast cells in the blood. 3. Lymphocytes in the bone marrow. 4. VMA in the urine.

1. Reed-Sternberg cells in the lymph nodes. a lymph node biopsy is done to confirm a histological dx and staging of Hodgkin disease.

Which of the following is correct regarding prognostic factors for determining survival for a child newly diagnosed with ALL? 1. The initial white blood cell count on diagnosis. 2. The race of the child. 3. The amount of time needed to initiate treatment. 4. Children aged 12 to 15 years.

1. The initial white blood cell count on diagnosis. Children with a normal or low white blood cell count who do not have non-T, non-B acute lymphoblastic leukemia and who are CALLA-positive have a much better prognosis than those with high cell counts or other cell types.

Which of the following is a reason to perform a lumbar puncture on a child with a diagnosis of leukemia? Select all that apply. 1. Rule out meningitis. 2. Assess the central nervous system for infiltration. 3. Give intrathecal chemotherapy. 4. Determine increased intracranial pressure. 5. Stage the leukemia.

2, 3 rationale for each: 1. There is no need to perform a spinal tap to rule out meningitis unless the patient has symptoms of meningitis. 2. A lumbar puncture is done to determine whether the cancer cells have entered the CNS, but this would not be routine unless the child was symptomatic. 3. Chemotherapy can also be given through a lumbar puncture (spinal tap). 4. ICP would be considered if the child had symptoms of headache, nausea, forceful vomiting, blurred or double vision, drowsiness, or seizure; an LP might then be performed. 5. Leukemia is not staged.

When caring for a child with lymphoma, the nurse needs to be aware of which of the following? 1. The same staging system is used for lymphoma and Hodgkin disease. 2. Aggressive chemotherapy with central nervous system prophylaxis will give the child a good prognosis. 3. All children with lymphoma need a bone marrow transplant for a good prognosis. 4. Despite high-dose chemotherapy, the prognosis is very poor for most children.

2. Aggressive chemotherapy with central nervous system prophylaxis will give the child a good prognosis. rationale for each: 1. The clinical staging system used in Hodgkin disease is of little value in lymphoma. Other systems have been developed. 2. The use of aggressive combination chemotherapy has a major impact on the survival rates for children with a diagnosis of lymphoma. Because there is usually bone marrow involvement, there is a need for central nervous system prophylaxis. 3. Not all children receive a bone marrow transplant. 4. Usually there is a good prognosis for lymphoma with aggressive chemotherapy.

What are the clinical manifestations of non-Hodgkin lymphoma? 1. Basically the same as those in Hodgkin disease. 2. Depends on the anatomical site and extent of involvement. 3. Nausea, vomiting, abdominal pain. 4. Behavior changes, jaundice, dry mouth.

2. Depends on the anatomical site and extent of involvement. rationale for each: 1. The clinical manifestations are different from those of Hodgkin disease, because the enlarged lymph nodes usually occur in the cervical area. 2. The clinical manifestations include symptoms of involvement. Rarely is a single sign or symptom diagnostic. Metastasis to the bone marrow or central nervous system may produce manifestations of leukemia. 3. The manifestations are not just limited to the abdomen, and NHL is not usually seen in young children. 4. Behavior changes, jaundice or dry mouth are not presenting signs of NHL.

Which of the following is the best method to prevent the spread of infection to an immunosuppressed child? 1. Administer antibiotics prophylactically to the child. 2. Have people wash their hands prior to contact with the child. 3. Assign the same nurses to care for the child each day. 4. Limit visitors to family members only.

2. Have people wash their hands prior to contact with the child. Hand washing is the best method to prevent the spread of germs and protect the child from infection.

A 5-year-old is admitted to the hospital with complaints of leg pain and fever. On physical examination, the child is pale and has bruising over various areas of the body. The health-care provider suspects that the child has ALL. The nurse informs the parent that the diagnosis will be confirmed by which of the following? 1. Lumbar puncture. 2. White blood cell count. 3. Bone marrow aspirate. 4. Bone scan.

3. Bone marrow aspirate. dx test that confirmed leukemia is examination of bone marrow aspirate

A teen is seen in clinic for a possible diagnosis of Hodgkin disease. The nurse is aware that which of the following symptoms should make the health-care provider suspect Hodgkin disease? 1. Fever, fatigue, and pain in the joints. 2. Anorexia with weight loss. 3. Enlarged, painless, and movable lymph nodes in the cervical area. 4. Enlarged liver with jaundice.

3. Enlarged, painless, and movable lymph nodes in the cervical area. Enlarged, painless, and movable lymph nodes in the cervical area are the most common presenting manifestations of Hodgkin disease.

Which of the following should be done to protect the central nervous system from the invasion of malignant cells in a child newly diagnosed with leukemia? 1. Cranial and spinal radiation. 2. Intravenous steroid therapy. 3. Intrathecal chemotherapy. 4. High-dose intravenous chemotherapy.

3. Intrathecal chemotherapy. Giving chemotherapy via lumbar puncture allows the drugs to get to the brain and helps prevent metastasis of the disease.

The parent of a child diagnosed with Wilms tumor asks the nurse what the treatment plan will be. The nurse explains the usual protocol for this condition. Which information should the nurse give to the parent? 1. The child will have chemotherapy and, after that has been completed, radiation. 2. The child will need to have surgery to remove the tumor. 3. The child will go to surgery for removal of the tumor and the kidney and will then start chemotherapy. 4. The child will need radiation and later surgery to remove the tumor.

3. The child will go to surgery for removal of the tumor and the kidney and will then start chemotherapy. rationale for each: 1. Chemotherapy is started after tumor removal, and radiation is done depending on stage and histological pattern. 2. Combination therapy of surgery and chemotherapy is the therapeutic management. 3. Combination therapy of surgery and chemotherapy is the primary therapeutic management. Radiation is done depending on clinical stage and histological pattern. 4. Radiation should be done after surgery and chemotherapy, depending on stage and histological pattern.

Which intervention should be implemented after a bone marrow aspiration? 1. Ask the child to remain in a supine position. 2. Place the child in an upright position for 4 hours. 3. Keep the child nothing by mouth for 6 hours. 4. Administer analgesics as needed for pain.

4. Administer analgesics as needed for pain. discomfort after procedure