Peds Hematological / Neoplastic

A nurse is leading a discussion with a group of new mothers about newborn nutrition and its importance for growth and development. One of the mothers asks, "Doesn't the baby get iron from me before birth?" Which response by the nurse would be most appropriate?

"Because the baby grows rapidly during the first months, he uses up what you gave him."

The child has been diagnosed with leukemia. Rank the following medications used to treat leukemia in order based on the stage of treatment.

4. oral steroids and vincristine through an intravenous line 3. high-dose methotrexate and 6-mercaptopurine 1. low doses of 6-mercaptopurine and methotrexate 2. chemotherapy through an intrathecal catheter

A parent calls the pediatric oncology clinic about the child having headaches after chemotherapy. What is the nurse's best advice?

Administer acetaminophen as needed

The nurse identifies that the client is at risk for an 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.

Having the child sleep in a single bed and room Encouraging frequent, thorough handwashing

A group of students are reviewing the effects of sickle cell anemia on the various parts of the body. The students demonstrate a need for additional study when they identify what as an effect?

High urine specific gravity

The nurse is caring for a 6-year-old girl with leukemia who is having an oncologic emergency. Which signs and symptoms would indicate hyperleukocytosis?

Tachycardia and respiratory distress

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

allopurinol

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

facial changes

A group of nursing students are reviewing the different types of chemotherapeutic agents used to treat childhood cancers. The students demonstrate understanding of the information when they identify which as antimetabolites? Select all that apply.

pernicious anemia iron deficiency anemia acute blood loss anemia folic acid deficiency anemia

Parents bring their daughter to the health care facility for evaluation. They report that lately the child seems rather pale and really tired. What would the nurse most likely find with further assessment if the child has acute lymphoblastic leukemia (ALL)? Select all that apply.

• Bleeding from the oral mucous membranes • Headache • Painless cervical lymphadenopathy • Low-grade fever

What are important considerations when the nurse is planning care for the family of a child with cancer? Select all that apply.

-Family's coping strategies-Monitoring for side effects of treatment-Stage of grief of child, parents, & siblings-Prognosis of cancer-Prevention & alleviation of pain

A nurse is administering a blood transfusion to a child. About 35 minutes after beginning the transfusion, the child develops pruritus and urticaria. Some wheezing is noted. Which action would the nurse take first?

Discontinue the transfusion.

A school-aged child is admitted to the hospital with a vaso-occlusive sickle cell crisis. Which measure in the child's care plan should be given priority?

Maintaining fluids through an intravenous line

The nurse develops a meal plan for a child with iron-deficiency anemia. Which meal would the nurse teach the parent has the highest amount of iron?

red meats, eggs, oatmeal, and dried fruit

The nurse is assessing an adolescent with suspected osteosarcoma. What would the nurse be least likely to assess?

severe bone pain

A nurse practitioner suspects a 13-month-old child has a neuroblastoma. Which diagnostic test would be most helpful in confirming the nurse practitioner's suspicion?

urine catecholamine metabolites

The nurse is educating the parents of a school-aged child with acute lymphoblastic leukemia (ALL). What statement by the parents indicates the parents need further education?

"My child will have a low hemoglobin and hematocrit levels because of bone marrow dysfunction."

A group of nursing students are reviewing the different types of chemotherapeutic agents used to treat childhood cancers. The students demonstrate understanding of the information when they identify which as antimetabolites? Select all that apply.

Cytarabine Hydroxyurea

A child has undergone a hematopoietic stem cell transplant. When assessing the child, the nurse notes the development of a maculopapular rash on the child's palms and bottoms of the feet. Which condition would the nurse suspect?

Graft-versus-host disease

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

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

The child has been diagnosed with cancer and is being treated with chemotherapy. Which findings are common side effects of this type of treatment? Select all that apply.

The child's mother states, "It seems like he catches every bug that comes along." The child reports feeling nauseated. The child's mother states that she often has to repeat herself because he can't hear very well. The child has no hair on his head.

An 8-month-old girl appears pale, irritable, and anorexic. On blood testing, the red blood cells are hypochromic and microcytic. The hemoglobin level is less than 5 g/100 mL, and the serum iron level is high. Which symptom should the nurse most expect as a result of excessive iron deposits?

an enlarged spleen

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

baseball

A nurse is caring for a child diagnosed with medulloblastoma. Which would the nurse expect to include as part of the child's plan of treatment? Select all that apply.

chemotherapy in high-risk cases radiation therapy complete surgical resection

A child with hypoplastic anemia develops hemosiderosis. What nursing instruction promotes the treatment goals?

infuse deferoxamine at home

A 5-year-old child is at the pediatric clinic for a well-child visit. Which symptom alerts the health care provider that this child might have acute lymphoblastic leukemia (ALL)?

lethargy, bruises, and lymphadenopathy

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

vitamin B12 injections

A 3-year-old child presents with bruising and mucous membrane bleeding from the nose and mouth. The nurse knows that these symptoms are indicative of:

von Willebrand disease.

The nurse is assessing a 2-year-old girl whose parents noticed that one of her pupils appeared to be white. Which assessments should the nurse expect to find if the girl has retinoblastoma? Select all that apply.

• Parents report that the child has headaches. • Observation confirms cat's eye reflex in pupil. • Assessment discloses hyphema in one eye. • History reveals strabismus.

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

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

The young boy has had his spleen surgically removed. Which statements by the boy's parents prior to discharge indicates that an adequate amount of learning has occurred?

"If he gets a fever, I'm going to call our physician right away." "Before he goes to the dentist, we'll make sure he gets antibiotics." "He's going to need several vaccines." "He's going to get really good at washing his hands."

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

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

The parents of a child diagnosed with rhabdomyosarcoma ask the nurse to explain what this means. What is the nurse's best response?

"The tumor is in the muscle."

While inspecting the skin of a child, the nurse notes blotchy areas of hemorrhage. When notifying the health care provider, the nurse would identify the client's skin as having:

ecchymosis

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

not to pick or irritate nose

The nurse is caring for a child with aplastic anemia. The nurse is reviewing the child's blood work and notes the granulocyte count is about 500, platelet count is over 20,000, and the reticulocyte count is over 1%. The parents ask if these values have any significance. Which response by the nurse is appropriate?

these values will help us monitor the disease

The nurse is caring for an 18-month-old client with suspected iron-deficiency anemia. The nurse will expect to prepare the client for which laboratory tests first?

Complete blood count and iron level

The nurse is evaluating the effectiveness of teaching provided to the parents of a school-age child prescribed liquid ferrous sulfate for iron-deficiency anemia. Which observations indicate that teaching has been effective? Select all that apply.

Parent places medication in orange juice. Child consumes fresh raw fruit and drinks water. Parent provides liquid-prepared medication to the child with a straw. Child goes to the bathroom to brush teeth immediately after taking the medication.

The nurse must calculate the absolute neutrophil count (ANC) for an immunosuppressed child. Which is the accurate ANC based on the following laboratory results? Total white blood cell count (WBC): 3000. WBC differential: 10% segmented neutrophils, 8% neutrophil bands.

The ANC is not measured directly; it must be calculated. Step 1: Determine the total percentage of neutrophils. 10% + 8% = 18% (0.18) Step 2: Multiply the WBC by the total percent of neutrophils. 3000 X 0.18 = 540 ANC

After teaching a group of students about hemophilia, the instructor determines that the students have understood the information when they identify hemophilia A as involving a problem with:

factor VIII

A child with sickle cell anemia comes to the emergency department for evaluation. The nurse suspects that the child is experiencing a vaso-occlusive crisis based on assessment of which signs and symptoms? Select all that apply.

fever low back pain distended abdomen

The nurse is caring for a child with disseminated intravascular coagulation (DIC). The nurse notices signs of neurologic deficit. Which nursing action is appropriate?

notify the physician

An adolescent who had radiation for a previous malignancy has presented to the pediatric oncology clinic. Which malignancy is the nurse concerned could develop as a complication?

osteosarcoma

The nurse is assessing a child in the pediatric intensive care unit. Which assessment finding(s) warrants immediate action? Select all that apply.

petechiae increased D-dimer assay painful joints clubbing of the nail beds

What is the priority action the nurse should take when caring for a child newly diagnosed with Wilms tumor (nephroblastoma)?

protect abdomen from manipulation

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

"I know this is scary, but leukemia has a 95% cure rate in children these days."

A nurse is providing care to a child with thalassemia major. The nurse understands that cure of the disorder is achieved with which treatment?

hypertransfusion therapy