Ricci Ch 46 PrepU (Peds HemeOnc)

Parents ask why their child just diagnosed with leukemia needs a "spinal tap." Which is the best response by the nurse? "It will help rule out a second malignancy." "Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system." "The spinal tap will help relieve pressure and headache for your child." "A sample of cerebrospinal fluid is needed to check for possible central nervous system infection."

"Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system." The cerebrospinal fluid is checked so the clinician can determine whether leukemic cells have invaded the central nervous system. It is common for a chemotherapy medication, usually methotrexate, to be administered immediately following lumbar puncture as treatment for potential infiltration.

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? "Don't worry, the health care provider is very good at treating leukemia." "I don't blame you for being upset; any parent would be scared too." "I know this is scary, but leukemia has a high cure rate in children these days." "You are very lucky to have caught it so early; that makes the treatments easier."

"I know this is scary, but leukemia has a high cure rate in children these days." Although cancer in children is rare compared to unintentional injury or infection, it is the leading medical cause of death among persons younger than 25 years of age. Fortunately, the overall survival rate for children with cancer today has improved. The overall 5-year survival rate is 84.5%, and for acute lymphoblastic leukemia (the most common form of childhood cancer), the 5-year survival is 88.5%

The parent tell the nurse that they recently saw a "white glow" in their infant's left pupil. How should the nurse respond? "Most parents mention a red color." "I will report this to the pediatrician." "Has your infant been rubbing either eye?" "A plugged tear duct would not be unusual."

"I will report this to the pediatrician." The "white glow" may indicate retinoblastoma; immediate investigation is needed. The red reflex is indicative of eye health. Eye rubbing and a plugged tear duct are unrelated to the symptom described.

The parents of a 6-year-old child with idiopathic thrombocytopenic purpura (ITP) ask the nurse conducting an assessment of the child what causes the disease. What is the nurse's best response? "ITP is primarily an autoimmune disease in which the immune system attacks and destroys the body's own platelets, for an unknown reason." "ITP is a serious bleeding disorder characterized by a decreased, absent, or dysfunctional procoagulant factor." "ITP occurs when the body's iron stores are depleted due to rapid physical growth, inadequate iron intake, inadequate iron absorption, or loss of blood." "ITP is characterized by the loss of surface area on the red blood cell membrane."

"ITP is primarily an autoimmune disease in which the immune system attacks and destroys the body's own platelets, for an unknown reason." Idiopathic thrombocytopenic purpura (ITP) is primarily an autoimmune disease, which is an acquired, self-limiting disorder of hemostasis characterized by destruction and decreased numbers of circulating platelets. The child will exhibit symptoms of excessive petechiae, purpura, and bruising. Hemophilia A and hemophilia B are distinguished by the particular procoagulant factor that is decreased, absent, or dysfunctional. Iron-deficiency anemia occurs when the body's iron stores are depleted. Hereditary spherocytosis (HS) is characterized by loss of surface area on the red blood cell membrane.

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

"Milk is a perfect food, and babies should be able to have all the milk they want." Babies with an inordinate fondness for milk can take in an astonishing amount and, with their appetites satisfied, may show little interest in solid foods. These babies are prime candidates for iron-deficiency anemia. Many children with iron-deficiency anemia, however, are undernourished because of the family's economic problems. A caregiver's knowledge deficit about nutrition is often present. Because only 10 percent of dietary iron is absorbed, a diet containing 8 to 10 mg of iron is needed for good health. During the first years of life, obtaining this quantity of iron from food is often difficult for a child. If the diet is inadequate, anemia quickly results.

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

"My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C." When ferrous sulfate is administered, it should be given between meals with juice (preferably orange juice, because vitamin C aids in iron absorption). For best results, iron should not be given with meals. Ferrous sulfate can cause constipation or turn the child's stools black.

A nurse is providing teaching to the parents of a child diagnosed with sickle cell anemia. The discussion is focused on precipitating factors for sickle cell crisis. Which statement by the parents requires the nurse to reinforce the teaching? "I make sure my child wears a good warm coat and gloves during winter." "Our family is taking a fun hiking trip up in the mountains next week." "We always take water along when we are on an outing." "I make sure our child is up to date on all immunizations."

"Our family is taking a fun hiking trip up in the mountains next week." High altitudes are a contributing factor for sickle cell crisis and should be avoided, as should flights in planes that are not pressurized. Extreme temperatures (hot or cold) are also triggers for a crisis so keeping warm during the winter is important. Dehydration and exposure to infection or other illness are precipitating factors for sickle cell crisis. Adequate hydration and keeping up with immunizations are imperative for health and wellness in a child diagnosed with sickle cell anemia.

A parent is angry about the adolescent's diagnosis of osteosarcoma. The parent is telling the adolescent that if he hadn't played football last year and broken his leg, this would not have happened. What is the nurse's best response to the parent's statement? "Playing sports does not cause osteosarcoma. It may draw attention to the weakened bone from the tumor, though." "When your adolescent broke the leg last year, it may have weakened the bone, allowing cancer to start there." "Does bone cancer run in your family? Maybe your adolescent inherited it through genes." "Cancer in the bone can result from old injuries so it probably was not caused from getting hurt last year, but an earlier injury."

"Playing sports does not cause osteosarcoma. It may draw attention to the weakened bone from the tumor, though." Osteosarcoma does not result from bone injuries but may be diagnosed when there is a fracture secondary to bone weakening from the tumor. Playing sports has no effect on development of osteosarcoma.

The nurse is preparing a child for discharge following a sickle cell crisis. Which statement by the mother indicates a need for further teaching? "She loves popsicles, so I'll let her have them as a snack or for dessert." "I bought the medication to give to her when she says she is in pain." "She has been down, but playing in soccer camp will cheer her up." "I put her legs up on pillows when her knees start to hurt."

"She has been down, but playing in soccer camp will cheer her up." Following a sickle cell crisis, the child should avoid extremely strenuous activities that may cause oxygen depletion. Fluids are encouraged, pain management will be needed, and the child's legs may be elevated to relieve discomfort, so these are all statements that indicate an understanding of caring for the child who has had a sickle cell crisis.

The nurse caring for a 14-year-old scheduled for magnetic resonance imaging (MRI) explains to a family how the test works. Which response accurately describes this test? "The MRI uses radio waves and magnets to produce a computerized image of the body." "The MRI is a nuclear scanning test to rule out cancer involving the bones or determine extent of bone involvement." "The MRI uses sound waves to create images that visualize body structures and locate masses." "The MRI uses radiation to examine soft tissue and bony structures of the body."

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

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."

"The drug you got to help with the nausea can cause dry mouth." Ondansetron is associated with dry mouth. Increasing IV fluids may or may not be appropriate. The child is urinating and his skin turgor is normal so it doesn't appear that he is dehydrated and in need of extra fluid. A severe allergic reaction would more likely be manifested by itching, hives, and increasing respiratory distress. Dry mouth is not an indicator of infection.

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." "There is a poor overall prognosis with a survival rate less than 10% and a median survival time of 2 years." "Survival is variable from several months to ten years or longer. Children who have a complete resection have the best prognosis." "The survival rate is greater than 95% with radiation and complete surgical resection."

"The prognosis is favorable with complete surgical resection and the child usually experiences minimal neurologic deficits post-operatively." Cerebral astrocytomas account for approximately 25% of all types of astrocytomas. The prognosis is favorable with complete surgical resection, and patients have minimal neurologic deficits post-operatively.

he 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? "The doctor will discuss these findings with you when he comes to the hospital." "These values will help us monitor the disease." "These labs are just common labs for children with this disease." "I'm really not allowed to discuss these findings with you."

"These values will help us monitor the disease." This response answers the parent's questions. In the nonsevere form, the granulocyte count remains about 500, the platelets are over 20,000, and the reticulocyte count is over 1%. The other responses do not address what the parents are asking and would block therapeutic communication.

The nurse is providing teaching about iron supplement administration to the parents of a 10-month-old child. It is critical that the nurse emphasize which teaching point to the parents? "You must precisely measure the amount of iron." "Your child may become constipated from the iron." "Please give him plenty of fluids and encourage fiber." "Place the liquid behind the teeth; the pigment can cause staining."

"You must precisely measure the amount of iron." The priority is to emphasize to the parents that they precisely measure the amount of iron to be administered in order to avoid overdosing. The other instructions are accurate, but the priority is to emphasize precise measurement.

A nurse is reviewing the laboratory test results of a 3-year-old child. Which absolute neutrophil count would the nurse identify as indicating neutropenia? 1.0 1.5 2.0 2.5

1.0 The normal absolute neutrophil count (ANC) ranges from 1.5 to 8.0 (1500 to 8000/mm3). An ANC less than 1.5 (1500/mm3) in children over age 1 indicates neutropenia.

The nurse is preparing a presentation for a local parent group about nutritional measures to prevent anemia. The group of parents have children between the ages of 4 and 8. The nurse would recommend a daily iron intake of which amount? 10 mg 6 mg 12 mg 15 mg

10 mg The recommended daily dietary iron intake for children 1 to 10 years of age is 10 mg. The recommended daily dietary iron intake for children 0 to 6 months of age is 6 mg. The recommended daily dietary iron intake for boys 11 to 18 years of age is 12 mg. The recommended daily dietary iron intake for girls 11 to 18 years of age is 15 mg.

The nurse is reviewing the results of a clotting study for a healthy 6-year-old. What would the nurse document as a normal prothrombin finding? 11.0 to 13.0 seconds 6.0 to 9.0 seconds 21.0 to 35.0 seconds 16.0 to 18.0 seconds

11.0 to 13.0 seconds The nurse would identify a prothrombin time of 11.0 to 13.0 seconds as normal for a healthy child. A result of 21.0 to 35.0 seconds would be the expected range for partial thromboplastin time and activated partial thromboplastin time. Findings of 6.0 to 9.0 seconds and 16.0 to 18.0 seconds are outside the normal range.

The nurse is caring for a child in sickle cell crisis. To best promote hemodilution, the nurse would expect to administer how much fluid per day intravenously or orally? 150 ml/kg of fluids 110 ml/kg of fluids 130 ml/kg of fluids per day 120 ml/kg of fluids per day

150 ml/kg of fluids To promote hemodilution in sickle cell crisis, the nurse would provide 150 ml/kg of fluids per day or as much as double maintenance, either orally or intravenously.

The nurse is caring for a 13-year-old boy with acute myelogenous leukemia who is experiencing feelings of powerlessness due to the effects of chemotherapy. What intervention will best help the teen's sense of control? B) Acknowledging the boy's feelings of anger with the disease C) Providing realistic expectations of treatments and outcomes D) Recognizing abilities that are unaffected by the disease

A) Involving the boy in decisions whenever possible Involving the boy in the decision-making process will best help his sense of control. Whether he is included in important decisions about therapy or minor decisions like menus or dress, it will give him a sense of control over his situation. Acknowledging feelings of anger, recognizing his abilities, and providing realistic expectations will reduce body image disturbance and build self-esteem

A young school-age child who is being treated for cancer has constipation and loss of appetite. What nursing interventions should the nurse suggest to the family? Select all that apply. Add high-fiber snacks such as popcorn and washed apples to the diet. Increase gross motor activities such as family walks. Use a rectal suppository at the same time each day. Provide adequate private time in the bathroom.

Add high-fiber snacks such as popcorn and washed apples to the diet. Increase gross motor activities such as family walks. Provide adequate private time in the bathroom. Fiber in the diet promotes bowel emptying. Even with decreased appetite, popcorn and apples are likely to be accepted. During chemotherapy, the nurse should be sure all fruits and vegetables are well washed. A simple gross motor activity such as walking stimulates peristalsis. Adequate private bathroom time will promote evacuation in the school-age child who is sensitive about bodily functions. Suppositories are avoided to prevent damage to the rectal mucosa.

A parent calls the pediatric oncology clinic about the child having headaches after chemotherapy. What is the nurse's best advice? Administer ibuprofen every 6 hours. Use an ice pack on the child's head. Administer acetaminophen as needed. Administer oral hydrocodone as needed.

Administer acetaminophen as needed. Caution parents, while children are receiving chemotherapy, not to give them nonsteroidal anti-inflammatory drugs because they may interfere with blood coagulation, a problem that may already be present because of lowered thrombocyte levels. Instead, suggest they use acetaminophen to relieve a headache. Ice packs are used to prevent hair loss and do not help with headaches. Hydrocodone is not needed for a headache.

The nurse in the emergency department is caring for a 10-year-old female child with sickle cell crisis. Child rates pain 10 on a scale of 0 to 10. Vital signs: 99.8°F (37.6°C); heart rate, 122 beats/min; blood pressure, 92/50 mm Hg; respiratory rate, 26 breaths/min; oxygen saturation, 92% on room air. The nurse receives orders for the child. Click to highlight the order(s) that needs to be implemented immediately. Orders: Administer acetaminophen for headache or temperature greater than 101°F (38.3°C). Administer oxygen to maintain oxygen saturation greater than 95%. Start normal saline continuous intravenous (IV) infusion at 200 ml/hr. Administer 100 mcg/kg morphine IV for pain prn q4 hours. Initiate a regular diet as tolerated.

Administer oxygen to maintain oxygen saturation greater than 95%. Start normal saline continuous intravenous (IV) infusion at 200 ml/hr. Administer 100 mcg/kg morphine IV for pain prn q4 hours. Nursing interventions should always be prioritized according to the ABCs (airway, breathing, circulation). Because the child's oxygen saturation is only 92% on room air, the nurse should apply oxygen to achieve an oxygen saturation of 95% or greater. After implementing measures to ensure a patent airway, the nurse should address circulation. In sickle cell crisis, the red blood cells (RBCs) clump together blocking microcirculation, which causes pain due to ischemia. The nurse should start intravenous (IV) fluids to prevent clumping of the RBCs to improve circulation. The child is reporting pain that is a 10 out of 10. The child will require an intravenous (IV) opioid analgesic such as morphine. The child's temperature is slightly elevated at 99.8°F (37.6°C). This is most likely due to dehydration (water is cooling, and less water in the body will increase the temperature slightly). Therefore, acetaminophen does not need to be administered. Initiating a regular diet at this time is not a priority. The child's respiratory rate of 18 breaths/min are within normal limits.

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

Administer the antiemetic before starting chemotherapy. Antiemetics are most effective when given before chemotherapy begins and then on a regular schedule to prevent nausea and vomiting throughout the administration of chemotherapy. Nonpharmacologic measures can be used in conjunction with antiemetics but not in place of them. Waiting to implement these measures could result in malnutrition.

The nurse is caring for a 6-year-old boy with an abdominal neuroblastoma prior to having a magnetic resonance imaging (MRI) scan without contrast done. Which intervention would the nurse expect to perform? Administering a sedative as ordered to keep the child still. Encouraging fluid intake to increase radionuclide uptake. Advising the physician that the child is allergic to shellfish. Applying EMLA to the injection site prior to inserting the IV.

Administering a sedative as ordered to keep the child still. The nurse would expect to administer a sedative as ordered to keep the child still because the machine makes a loud thumping noise that could frighten the child. The child must lie without moving while the MRI is being done. Encouraging fluid intake to increase radionuclide uptake is necessary for a bone scan. Advising the physician that the child is allergic to shellfish is an intervention for a computed tomograph (CT) scan with contrast. If the child did not have an IV prior to the MRI and contrast was going to be used, then an IV would need to be inserted for the contrast after the noncontrast MRI was finished. Applying EMLA to an injection site prior to inserting an IV would be appropriate for both the CT and bone scans.

The nurse is working with a child who is in sickle cell crisis. Treatment and nursing care for this child include which actions? Select all that apply. Administering oxygen Administering analgesics Maintaining fluid intake Promoting exercise and activity Administering platelets

Administering oxygen Administering analgesics Maintaining fluid intake A vaso-occlusive crisis occurs when sickle-shaped cells are clumped together in a joint or organ. This causes severe pain and hypoxia to the tissues. The management for a vaso-occlusive crisis is to provide adequate pain relief, oxygen to correct the hypoxemia, and increased IV fluids to thin out viscosity and allow the cells to flow in the vascular system. Platelet administration is not indicated as part of the treatment. Children and adults experiencing a sickle cell crisis experience a high degree of pain, so exercise and activity is postponed until the crisis is over. Activity is encouraged when the child is not in crisis as it promotes growth and a positive self-image.

The nurse will use a special needle to start intravenous (IV) fluids through which central venous access device? A peripherally inserted central catheter An implanted port A tunneled central catheter A multilumen catheter

An implanted port An implanted port requires a special (Huber) needle placed through the skin into the port, which is implanted surgically under the skin and over a bony prominence. The peripherally inserted central catheter (PICC) and tunneled catheters (Broviac, Hickman, Groshong) do not require a special needle for access. A multilumen catheter has more than one lumen but is not a port.

The nurse is providing preoperative care for a 7-year-old boy with a brain tumor, as well as his parents. Which intervention is a priority? Assessing the child's level of consciousness. Providing a tour of the intensive care unit. Educating the child and parents about shunts. Having the child talk to another child who has had this surgery.

Assessing the child's level of consciousness. The priority intervention is to monitor for increases in intracranial pressure because brain tumors may block cerebral fluid flow or cause edema in the brain. A change in the level of consciousness is just one of several subtle changes that can occur indicating a change in intracranial pressure. Lower priority interventions include providing a tour of the ICU to prepare the child and parents for after the surgery, and educating the child and parents about shunts.

A 4-year-old child diagnosed with Wilms tumor is admitted for surgery. What information would be most important for the nurse to include in the child's preoperative plan of care? Avoiding further abdominal palpation Performing dressing changes to the affected area Administering analgesics for pain Preparing the child for amputation

Avoiding further abdominal palpation After the initial assessment is performed on a child with Wilms tumor, further palpation of the abdomen should be avoided because the tumor is highly vascular and soft. Therefore, excessive handling of the tumor may result in tumor seeding and metastasis. Preoperatively, the child with Wilms tumor does not have a wound; therefore, dressing changes are not necessary. Although the child may experience abdominal pain, avoiding further abdominal palpation would be the priority. Surgical removal of the tumor and affected kidney is the treatment of choice for Wilms tumor. Amputation would be more likely for a child with osteosarcoma.

The nurse is caring for an 8-year-old girl who has been diagnosed with leukemia and will have a variety of tests, including a lumbar puncture, before beginning chemotherapy. What action would be the priority? A) Applying EMLA to the lumbar puncture site B) Educating the child and family about the testing procedures C) Administering promethazine as ordered for nausea D) Educating the family about chemotherapy and its side effects

B) Educating the child and family about the testing procedures The priority would be educating the child and family about the testing procedures,so they know what to expect and understand why the tests are being performed. Applying EMLA to the lumbar puncture site will be done prior to the procedure. The family will be educated about chemotherapy and its side effects prior to the therapy beginning, and promethazine or other antiemetics will be administered once chemotherapy has begun

A group of nursing students are studying information about childhood cancers in preparation for a class examination. They are reviewing how childhood cancers differ from adult cancers. The group demonstrates understanding of the information when they identify what location as an unlikely site for childhood cancer? Bladder Blood Brain Kidney

Bladder The most common sites for childhood cancer include the blood, lymph, brain, bone, kidney, and muscle. Bladder is a common site for adult cancer.

What is one advantage of an implanted port (central venous access device) that the nurse will explain to an adolescent? No tunneling is needed when the port is inserted. Flushing of the device is not necessary. Body appearance changes very little. No special procedure is necessary for removal.

Body appearance changes very little. An implanted port has nothing extending through the skin and may be obvious only as a slight protrusion at the insertion site. Some tunneling from the port to a central vein is needed. Removal of the port requires a surgical procedure. Flushing of the port is necessary when used and on a regular basis.

The nurse is admitting to an examination room a child with the diagnosis of "probable acute lymphoblastic leukemia (ALL)." What will confirm this diagnosis? Complete white blood count Lethargy, bruising, and pallor History of leukemia in twin Bone marrow aspiration

Bone marrow aspiration Bone marrow aspiration and biopsy are diagnostic. An abnormal white blood count and symptoms of lethargy, bruising, and pallor only create suspicion of leukemia; a twin may or may not be affected.

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

Calling the doctor if the child gets a sore throat Calling the doctor if the child gets a sore throat is the priority. Because of the child's impaired immune system, any sign of potential infection, such as sore throat, must be evaluated by a physician. Using acetaminophen if the child needs an analgesic, writing down phone numbers and appointments, and keeping a written copy of the treatment plan are important teaching points—but secondary to guarding against infection.

Individuals with hemophilia B have a deficiency in factor IX, which can cause excessive blood loss. What is another name for this clotting factor? Christmas factor Stuart factor Antihemophilic factor Proconvertin

Christmas factor Factor IX is also known as plasma thromboplastin component or Christmas factor. Its function is to activate factor X. Factor X is the Stuart factor. Stuart factor's function is to activate factor II in the clotting cascade. Factor VIII is the antihemophilic factor. It is a platelet cofactor and also helps activate factor X. Factor VII is proconvertin. It is considered a stable factor and also acts to activate factor X.

The nurse is caring for a 16 -year-old boy with acute myelogenous leukemia who is having chemotherapy and who has incomplete records for varicella zoster immunization. Which is the priority nursing diagnosis? A) Pain related to adverse effects of treatment verbalized by the child B) Nausea related to side effects of chemotherapy verbalized by the child C) Constipation related to the use of opioid analgesics for pain D) Risk for infection related to neutropenia and immunosuppression

D) Risk for infection related to neutropenia and immunosuppression The priority nursing diagnosis is risk for infection related to neutropenia and immunosuppression. The incomplete records for varicella zoster immunization can cause a problem since exposure to chickenpox could cause sepsis, so the nurse should contact the oncologist for approval to administer the vaccine. Certain vaccines are not administered when the child is immunosuppressed, so timing is crucial. Diagnoses for pain and nausea are valid for this child because he is undergoing chemotherapy, but they are not a priority. Likewise, the need for constipation management would not be necessary unless opioid use begins

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

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

The pediatric nurse reviews the radiographs of a child and observes that there are lesions on the bone. The nurse interprets this finding as suggesting which condition? Ewing sarcoma Hodgkin disease non-Hodgkin lymphoma neuroblastoma

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

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

Football injuries do not contribute to the development of a tumor. Osteosarcoma is the most malignant form of bone cancer. It is caused by the embryonic mesenchymal tissue that forms in the bones. A football injury may predispose more scrutiny of a lesion, but it will not be the cause of the cancer, nor will the dislike of milk. Osteosarcoma may be treated with chemotherapy and radiation. It may also involve an amputation. The parents who state they are angry at their adolescent for playing football are more likely projecting their fears of the diagnosis and it what it means for their child's future.

The nurse assesses that the client is at risk for an infection related to chemotherapy-induced immunosuppression. What will the nurse include in the teaching plan for the child and parents to help reduce this risk? Select all that apply. Have the child sleep in a single bed and room. Encourage frequent, thorough handwashing. Provide a low-carbohydrate, low-protein diet. Encourage frequent contact with multiple visitors. Cheer up the environment with fresh flowers and plants.

Have the child sleep in a single bed and room. Encourage frequent, thorough handwashing. To reduce the risk for infection, the nurse should teach the child and parents about minimizing the child's exposure to potentially infectious situations. The nurse should encourage the parents to arrange for the child to sleep in a single bed and room and, if possible, avoid close contact with other family members who may be developing upper respiratory tract infections. Thorough and frequent handwashing, especially after using the bathroom and before eating, is essential. A high-calorie, high-protein diet helps to rebuild white blood cells and should be encouraged. If possible, the child's exposure to large crowds and visitors should be limited because of the increased risk of infection from these individuals. Fresh flowers and plants should be avoided because they could harbor mold spores.

A nurse is preparing a 7-year-old girl for bone marrow aspiration. Which site should she prepare? Iliac crest Sternum Anterior tibia Femur

Iliac crest Bone marrow aspiration provides samples of bone marrow so the type and quantity of cells being produced can be determined. In children, the aspiration sites used are the iliac crests or spines (rather than the sternum, which is commonly used in adults) because performing the test at these sites is usually less frightening for children; these sites also have the largest marrow compartments during childhood. In neonates, the anterior tibia can be used as an additional site.

Which nursing diagnosis would be most appropriate for a child with idiopathic thrombocytopenic purpura? Ineffective tissue perfusion related to poor platelet formation Risk for altered urinary elimination related to kidney impairment Risk for infection related to abnormal immune system Ineffective breathing pattern related to decreased white blood count

Ineffective tissue perfusion related to poor platelet formation Idiopathic thrombocytopenic purpura (ITP) results from an immune response following a viral infection that produces antiplatelet antibodies. These antibodies destroy the platelets which cause petechiae, purpura, and excessive bleeding. ITP does not affect the kidneys. Breathing difficulties would not occur with decreased white blood cells. It occurs when there is decreased red blood cells. The child who develops ITP has no different immune system than other children who are healthy.

A nurse is reviewing laboratory test results of a child with iron-deficiency anemia. Which laboratory results would be communicated with the next shift during shift hand-off? Select all that apply. Hemoglobin 11.8 g/100 ml Serum iron 70 ug/100 ml Iron-binding capacity 390 ug/100 ml Serum ferritin 8 ug/100ml Hematocrit 30%

Iron-binding capacity 390 ug/100 ml Serum ferritin 8 ug/100ml Hematocrit 30% As iron-deficiency anemia develops, laboratory studies will reveal a decreased hemoglobin level (less than 11 g/100 ml of blood) and reduced hematocrit level (below 33%). The red blood cells are microcytic, hypochromic, and possibly poikilocytic (irregular in shape). The mean corpuscular volume is low. The mean corpuscular hemoglobin may be reduced. Serum iron levels are normally 70 g/100 ml; with iron-deficiency anemia the level is often as low as 30 g/100 ml, with an increased iron-binding capacity (more than 350 g/100 ml). The level of serum ferritin reflects the extent of iron stores so is less than 10 g/100 ml (normal is 35 g/ml).

A 14-year-old adolescent with Hodgkin disease is experiencing difficulty breathing and is sent for a radiograph. Which finding should the nurse expect to see on the x-ray report? Mediastinal mass Retinoblastoma Lymphadenopathy Tumor in the liver

Mediastinal mass Difficulty breathing or respiratory distress may indicate a mediastinal mass (which may be seen on a radiograph) in the client with Hodgkin disease. Hepatomegaly or splenomegaly may occur when there is advanced disease. Lymphadenopathy is present in the cervical and supraclavicular nodes. These could be palpated and do not require an x-ray to diagnose. Presence of a white reflection in the pupil of the eye may indicate retinoblastoma.

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

Monitor the site dressing and vital signs. Monitoring vital signs and the dressing for signs of bleeding is a priority after bone marrow aspiration. Although providing pain medication, educating on handwashing, and allowing for therapeutic play are all important, these should only be performed after first stabilizing the child.

The nurse is caring for a 6-year-old boy with non-Hodgkin lymphoma who is being treated with monoclonal antibodies. What recommendation would the nurse include in the child's plan of care? Monitoring for allergic reactions or anaphylaxis. Assessing the child's hydration status secondary to vomiting. Monitoring for complaints of bone pain. Assessing for signs of capillary leak syndrome.

Monitoring for allergic reactions or anaphylaxis. The nurse would monitor for infusion-related reactions and anaphylaxis if monoclonal antibodies were administered and would have epinephrine, antihistamines, and steroids available at the bedside for treatment if a reaction occurred. Assessing the level of hydration due to vomiting would be necessary if tumor necrosis factor was administered. The flu-like symptoms produced by interferons also require hydration maintenance. Monitoring for complaints of bone pain is appropriate when administering colony-stimulating factors such as filgrastim or sargramostim. Assessing for signs of capillary leak syndrome within 2 to 12 hours of the start of treatment is necessary when interleukins are used.

The pediatric nurse is explaining to a new graduate nurse the differences in planning well-child maintenance for a child with cancer. Which statement by the new nurse demonstrates understanding of the teaching? No routine live vaccines are administered while on chemotherapy. Siblings and parents should not receive nonlive vaccines. Growth may be stunted due to chemotherapy. Eliminate second-hand smoke within the home.

No routine live vaccines are administered while on chemotherapy. Children with cancer need much of the same well-child maintenance care that all children do, with one exception. While they are undergoing chemotherapy, which causes a decreased immune response, they should not receive "routine" vaccines, especially live vaccines. The siblings in the home can receive all nonlive vaccines, and the entire family (including the child undergoing treatment) is encouraged to receive a yearly flu vaccine. Growth and development are monitored during well-child visits, but it is not necessarily true that growth and development may be stunted. It is always a good idea to eliminate second-hand smoke for all children, not just for children with cancer. Childhood cancers do not seem to be related to environmental contaminants.

The nurse is caring for a child with disseminated intravascular coagulation (DIC). The nurse notices signs of neurologic deficit. Which nursing action is appropriate? Continue to monitor neurologic signs. Notify the physician. Evaluate respiratory status. Inspect for signs of bleeding.

Notify the physician. If neurologic deficits are assessed, immediate reporting of the findings is necessary to begin treatment to prevent permanent damage.

The nurse is assessing a 3-year-old boy whose mother reports that he is listless and has been having trouble swallowing. Which finding suggests the child may have a brain tumor? Observation reveals nystagmus and head tilt. Vital signs show blood pressure measures 120/80 mm Hg. Examination shows temperature of 101.4° F (38.6°C) and headache. Observation reveals a cough and labored breathing.

Observation reveals nystagmus and head tilt. Coupled with the mother's reports, observation of nystagmus and head tilt suggest the child may have a brain tumor. Elevated blood pressure of 120/80 mm Hg may be indicative of Wilms tumor. Fever and headaches are common symptoms of acute lymphoblastic leukemia. A cough and labored breathing points to rhabdomyosarcoma near the child's airway.

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

Practice frequent, gentle oral hygiene Frequent, gentle oral hygiene will keep the vulnerable oral mucosa clean and will prevent secondary infection. Offering only cool, clear liquids will limit nutrition. Freely choosing foods and beverages gives some control to the 6-year-old but is likely to result in ingestion of foods that are irritating to the mouth, lips, and throat. Lidocaine used as a rinse can create risks for children younger than 8 years because often some is swallowed, and this inhibits the gag reflex.

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

Prepare to administer factor replacement medication Many clients with hemophilia have repeated episodes of hemarthrosis or bleeding into the joints, and develop functional impairment of the joints, despite careful treatment. To assist in limiting impairment, the nurse would prepare to administer factor replacement medications, such as plasma, recombinant clotting factor VIII, or a clotting promotor medication. The nurse would document the finding, notify the health care provider, and assess the client for additional symptoms after limiting the amount of blood loss.

The nurse is caring for a child with idiopathic thrombocytopenic purpura with a platelet count of 24,000/mm3. Which health care provider prescription will the nurse question? Transfuse 1 unit of platelets. Administer prednisone orally. Provide ibuprofen as needed for pain. Give intravenous immunoglobulin (IVIG).

Provide ibuprofen as needed for pain. The child with idiopathic thrombocytopenic purpura (ITP) should not receive ibuprofen or salicylates because this prevents platelet aggregation, which can cause increased bleeding. Administration of platelets may be used as a temporary measure to increase the platelet count. Because ITP is thought to be an autoimmune illness, prednisone (a corticosteroid) is used to decrease the immune response. IVIG is used to treat ITP.

A child is undergoing a series of diagnostic tests for a suspected malignancy. Which diagnostic test result is only present in Hodgkin disease? elevated lymphocytes Reed-Sternberg cells T-lymphocyte surface markers megakaryocyte cells

Reed-Sternberg cells With Hodgkin disease, lymphocytes proliferate in the lymph glands, and special Reed-Sternberg cells (large, multinucleated cells that are probably nonfunctioning monocyte-macrophage cells) develop. Although these lymphocytes are capable of DNA synthesis and mitotic division, they are abnormal because they lack both B- and T-lymphocyte surface markers and cannot produce immunoglobulins as do usual B-lymphocytes. There will be elevated lymphocytes, but this is present in leukemias as well. T-lymphocyte surface markers are lacking in Hodgkin disease. Megakaryocyte cells are normal cells in the bone marrow and produce platelets.

Which nursing diagnosis should the nurse identify as being the mostappropriate for a child with idiopathic thrombocytopenic purpura? Risk for infection related to abnormal immune system Risk for bleeding related to insufficient platelet formation Risk for altered urinary elimination related to kidney impairment Ineffective breathing pattern related to decreased white blood count

Risk for bleeding related to insufficient platelet formation Idiopathic thrombocytopenic purpura is the result of a decrease in the number of circulating platelets in the presence of adequate megakaryocytes, which are precursors to platelets. Because bleeding can occur with this disease process, the diagnosis most appropriate for the client at this time is risk for bleeding related to insufficient platelet formation. Reduced numbers of platelets would not increase the client's risk for infection. Reduced numbers of platelets does not increase the client's risk for renal impairment. Reduced risk of platelets will not lead to an ineffective breathing pattern.

A 5-year-old client has been diagnosed with leukemia and is currently on chemotherapy and radiation. The child is having difficulty due to mucositis. Which is the most appropriate nursing diagnosis for this child? Pain due to neoplastic process in bone Disturbed body image related to loss of hair after chemotherapy Compromised family coping related to long-term chemotherapy regimen Risk for imbalanced nutrition, less than body requirements, related to inflammation

Risk for imbalanced nutrition, less than body requirements, related to inflammation Mucositis is inflammation of the oral mucosa, which puts this child at risk for risk for imbalanced nutrition. The client may have pain due to neoplastic process in the bone, but that is not mentioned in the scenario. The client may have lost hair, but that is not mentioned. The client's family coping is also not mentioned.

The nurse is collecting data from the caregivers of a child brought to the clinic setting. The parents tell the nurse that the child's skin seems to be an unusual color. The nurse notes that the child's skin appears bronze-colored and jaundiced. This observation alerts the nurse to the likelihood that this child has which disorder? Hemophilia Sickle cell disease Kawasaki disease Thalassemia

Thalassemia In the child with thalassemia the skin may appear bronze-colored or jaundiced. The child with hemophilia may have bruised areas on the skin. The skin color in children with sickle cell disease may be pale in color, and with Kawasaki disease the child may have a rash on the trunk and extremities.

A 6-year-old child has been found to have a stage II brain tumor. The parent asks the nurse to explain what "stage II" means. Which information would the nurse provide? The cancer has spread in the brain itself but the chance of complete surgical removal is good. The tumor has not extended into the surrounding tissue and can be completely removed surgically. Cancer cells have spread to local lymph nodes. Tumors have spread systemically throughout the body.

The cancer has spread in the brain itself but the chance of complete surgical removal is good. Knowing the stage of a tumor helps the health care team design an effective treatment program, establish an accurate prognosis, and evaluate the progress or regression of the disease. In general, stage I refers to a tumor that has not extended into the surrounding tissue so can be completely removed surgically; stage II means there is some local spread but the chance for complete surgical removal is good. Stage III typically means cancer cells have spread to local lymph nodes; stage IV designates tumors that have spread systemically (metastasis).

A child with iron-deficiency anemia is prescribed ferrous fumarate, 3 mg/kg/day in two divided doses. What does this prescription indicate to the nurse? The child requires a prophylactic dose of iron. The child has mild to moderate iron deficiency. The child has severe iron deficiency. The child is being prepared for packed red blood cell administration.

The child has mild to moderate iron deficiency. The recommended dosage for iron supplementation for a child with mild to moderate iron deficiency is 3 mg/kg/day of ferrous fumarate. A prophylactic dose is 1 to 2 mg/kg/day of up to a maximum of 15 mg elemental iron per day. Severe iron deficiency requires 4 to 6 mg/kg/day of elemental iron in three divided doses. Transfusion of packed red blood cells is reserved for the most severe cases. Prior to the transfusion of packed red blood cells, the nurse would follow specific blood bank guidelines.

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

The child has redness or swelling at the central venous access site. The family should contact the health care provider if the child exhibits redness, swelling, or leakage at the central venous access site; or if the device has cracks, is pulled out, or does not flush. Loss of apetite, increased urinary output and vomitting, and bruising are expected adverse effects. The parent only need contact the health care provider if these effects become excessive.

Which symptom would lead the nurse to suspect that a child is developing a common side effect of vincristine? The cheeks are turning bright red. The child says the fingertips feel numb. The child says the teeth "ache." The child's hearing seems to be altered.

The child says the fingertips feel numb. Vincristine has a number of side effects. Myelosuppression occurs,, which can cause decreased blood counts, hemorrhage, and anemia. A common side effect of vincristine is numbness and tingling in the hands and feet. Allopurinol is administered when the child is receiving vincristine, because the dying cancer cells cause increased uric acid. A side effect of the allopurinol is blistering, peeling, and red skin rash. With both of the drugs the child should be properly hydrated to prevent side effects. Toothache and hearing loss are symptoms of side effects of other chemotherapeutic agents, but not vincristine.

A 13-year-old, diagnosed with beta-thalassemia major is seen in the pediatric clinic. The nurse completes an assessment and notes that the client is below the 10th percentile in height for age. What assumption can the nurse make based on this information? This finding is a common manifestation of the client's diagnosis. Further assessment of the nutritional status is warranted. The client should be referred for further evaluation. The client is due for a growth spurt and should catch up in height.

This finding is a common manifestation of the client's diagnosis. Short stature is a common manifestation of thalassemia major. Because short stature is a common manifestation of the disorder, a nutritional assessment is not warranted. While growth spurts can occur at this age, the client will probably not catch up, because the short stature is due to the thalassemia.

The nurse is caring for a child admitted to the hospital for an open fracture of the femur following a motor vehicle accident. The nurse notes the following lab values: white blood cells 10,000/mm3, hemoglobin 7.9 g/dl (79 g/L), hematocrit 28%, platelets 151,000/mm3. Which nursing action is priority? Ask the child to rate pain on a scale 0 to 10. Administer antibiotics intravenously stat. Transfuse 1 unit of packed red blood cells. Provide the family with preoperative instructions.

Transfuse 1 unit of packed red blood cells. In a situation where the child exhibits signs of anemia related to acute hemorrhage, the nurse should anticipate administering a transfusion of packed red blood cells to improve oxygenation and circulation. Administration of antibiotics, pain assessment, and family education can be performed after the beginning the blood transfusion.

The nurse is preparing clients for diagnostic testing for cancer. Which test is used to differentiate a neuroblastoma from other tumors? Urine catecholamine metabolites, homovanillic acid (HVA), and vanillylmandelic acid (VMA) Urinalysis Serum chemistries Complete blood count (CBC) with differential

Urine catecholamine metabolites, homovanillic acid (HVA), and vanillylmandelic acid (VMA) Neuroblastomas produce catecholamines. Urine catecholamine metabolites, homovanillic acid (HVA), and vanillylmandelic acid (VMA) differentiate neuroblastomas from other tumors. This exam is done by collecting a 24-hour urine specimen. Urinalysis provides general information about renal function. Serum chemistries help to evaluate the body's response to the cancer process. CBC with differential determines abnormal loss or destruction of cells that may indicate cancer or bone marrow suppression.

A nurse is providing care for a child with disseminated intravascular coagulation (DIC). What would alert the nurse to possible neurologic compromise? Widely fluctuating blood pressure Equal pupillary response Hematuria Petechiae

Widely fluctuating blood pressure A key aspect of the nurse's role is to assess the child for signs and symptoms of impaired tissue perfusion in the various body systems that may be affected by DIC. Unstable or abnormal blood pressure (such as wide BP fluctuations) or unequal pupil size may suggest neurologic compromise. Hematuria would suggest renal compromise. Petechiae would be indicative of bleeding into the skin.

The nurse has received morning report on a group of pediatric clients. Which pediatric client will the nurse see first? a child with hemophilia reporting knee pain and edema a child with sickle cell anemia requesting a cool compress a child experiencing a palpable purpural rash and arthralgia a child reporting lethargy with a history of thalassemia major

a child with hemophilia reporting knee pain and edema The child with hemophilia should be quickly evaluated when reporting joint pain as this could indicate bleeding. A child with sickle cell anemia requesting a cool compress is experiencing a psychosocial need. A child experiencing a purpural rash and arthralgia (joint pain) is exhibiting signs of Henoch-Schonlein purpura. Lethargy can be a symptom of thalassemia major.

A nurse is assessing a child with cancer and suspects that the child has developed sepsis based on what findings? Select all that apply. absolute neutrophil count (ANC) less than 500 increased blood urea nitrogen (BUN) hyperkalemia thrombocytosis respiratory alkalosis

absolute neutrophil count (ANC) less than 500 increased blood urea nitrogen (BUN) hyperkalemia Findings associated with sepsis include ANC less than 500, increased BUN, increased potassium, decreased platelets, and metabolic acidosis.

The nurse is caring for 9-year-old boy undergoing chemotherapy whose complete blood count (CBC) with differential reports 7% banded and 13% segmented neutrophils with a white blood cell count of 2,540. He has an oral temperature of 38.6°C (101.5°F). Which intervention would be the priority? administering prescribed broad-spectrum IV antibiotics monitoring his vital signs every 4 hours restricting visitors with symptoms of infection assessing for signs of infection every 8 hours

administering prescribed broad-spectrum IV antibiotics The priority intervention for this child is administering prescribed broad-spectrum IV antibiotics. His absolute neutrophil count (ANC; calculated by adding the bands and segs [21%] and then multiplying this [0.20] by the white blood cell count [2540] to yield an ANC of 508) indicates he has neutropenia and his temperature indicates he may have an infection. Monitoring vital signs, restricting visitors with symptoms of infection, and assessing for signs of infection are valid interventions related to neutropenia but are of lesser importance at this point.

The 2-year-old child receiving treatment for a cancer diagnosis is seen for a well-child checkup. Which health maintenance activity will the nurse exclude? plotting height and weight on a growth chart assessing dietary intake by addressing "picky eating" and "food jags" administering the measles, mumps, rubella (MMR) vaccine teaching the importance of taking water safety measures

administering the measles, mumps, rubella (MMR) vaccine Live vaccines (viral or bacterial) should not be administered to an immunosuppressed child because of the risk of causing disease. The other health maintenance activities are important for the health maintenance of the child and should be included during the well-child visit.

After teaching a group of nursing students about chemotherapy agents used in treatment cancer, the instructor determines that the teaching was successful when the students identify cisplatin as which type of drug? alkylating agent antimetabolite antitumor antibiotic hormone

alkylating agent Cisplatin is classified as an alkylating agent. Antimetabolites include 5-fluorouracil and gemcitabine. Antitumor antibiotics include bleomycin and dactinomycin. Hormones include dexamethasone, hydrocortisone, and prednisone.

A pediatric client is diagnosed with an infratentorial tumor of the brain. The nurse would identify which as a possible site for this type of tumor? brain stem temporal lobe frontal lobe occipital lobe

brain stem Infratentorial tumors are located in the brain stem, fourth ventricle, and cerebellum. Supratentorial tumors are located in the cerebrum.

The nurse is providing care to a child with leukemia. When assessing the child, which signs and symptoms would the nurse likely find? Select all that apply. bruising anorexia sore throat lymphadenopathy increased platelet count increased hemoglobin

bruising anorexia sore throat lymphadenopathy Clinical and diagnostic features of leukemia include fatigue, weakness, pallor, fever, bruising, bleeding (e.g., petechiae or purpura), weight loss, anorexia, swollen gums, sore throat, recurrent infections, flu-like symptoms, abdominal pain, nausea, vomiting, bone pain, lymphadenopathy, splenomegaly, hepatosplenomegaly, elevated leukocyte count, decreased hemoglobin, and platelet counts.

The nurse is administering meperidine as ordered for pain management for a 10-year-old boy in sickle cell crisis. The nurse would be alert for: seizures. behavioral addiction. priapism. leg ulcers.

seizures. Repeated use of meperidine for pain management during sickle cell crisis increases the risk of seizures when used in children with sickle cell anemia. Behavioral addiction is rarely a concern in the child with sickle cell anemia if the opioid is used for the alleviation of severe pain. Priapism is a complication of sickle cell anemia unrelated to meperidine administration. Leg ulcers are a complication of sickle cell anemia unrelated to meperidine administration.

A nurse in the emergency department is examining a 6-month-old with symmetrical swelling of the hands and feet. The nurse immediately suspects: Cooley anemia. idiopathic thrombocytopenic purpura (ITP). sickle cell disease. hemophilia.

sickle cell disease Symmetrical swelling of the hands and feet in the infant or toddler is termed dactylitis; aseptic infarction occurs in the metacarpals and metatarsals and is often the first vaso-occlusive event seen with sickle cell disease. Symmetrical swelling of the hands and feet are not typically seen with the other conditions listed.

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

cheeseburger, broccoli, and fresh strawberries Children with iron-deficiency anemia require diets rich in iron and vitamin C (vitamin C enhances iron absorption). Meats are excellent sources of iron. Broccoli is a good source of iron, and strawberries are a good source of vitamin C. To help the body absorb the most iron from the meal, tea and foods rich in calcium (such as milk and cheese) should be avoided.

After teaching the parents of a child diagnosed with sickle cell disease, the nurse determines that the teaching was successful when the parents state that they will contact the primary health care provider if the child develops which signs or symptoms? Select all that apply. chest pain severe dizziness sudden change in vision constipation irritability

chest pain severe dizziness sudden change in vision The parents should contact the primary health care provider if the child develops a fever, dizziness or severe headaches, severe stomach pain or swelling, sudden changes in vision, weakness, or loss of consciousness. There is no need to notify the primary health care provider if the child develops constipation or irritability.

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? hemoglobin and white blood cell levels iron and thrombocyte levels complete blood count and iron level ferritin and glycosylated hemoglobin levels

complete blood count and iron level The nurse would expect the client to undergo a complete blood count, hemoglobin, hematocrit, reticulocyte, iron, ferritin, and free erythrocyte protoporphyrin levels to confirm the diagnosis. Laboratory evaluation will reveal decreased hemoglobin and hematocrit, decreased reticulocyte count, microcytosis, and hypochromia, decreased serum iron and ferritin levels, and increased FEP level. The other findings do not point to iron-deficiency anemia. A white blood cell is used to diagnosis infection. A thrombocyte level is used to assess platelet counts. Glycosylated hemoglobin levels are used to assess glucose levels over the past 2 to 3 months.

A nurse caring for an 8-year-old child with a bleeding disorder documents the following nursing diagnosis: Ineffective tissue perfusion related to intravascular thrombosis and hemorrhage. This nursing diagnosis would be most appropriate for a child diagnosed with which condition? disseminated intravascular coagulation von Willebrand disease hemophilia iron-deficiency anemia

disseminated intravascular coagulation Disseminated intravascular coagulation (DIC) is an acquired coagulopathy that, paradoxically, is characterized by both thrombosis and hemorrhage. The outcome for this client is: The child will maintain adequate tissue perfusion of all body systems affected by DIC and regain adequate laboratory values for hemostasis. von Willebrand disease and hemophilia involve hemorrhage but not thrombosis. Iron deficiency anemia does not involve either hemorrhage or thrombosis.

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: platelets. factor IX. plasmin. factor VIII.

factor VIII. In hemophilia A, the problem is with factor VIII, and in hemophilia B the problem lies with factor IX. Platelets are problematic in idiopathic thrombocytopenic purpura (ITP). Plasmin is involved in the pathophysiologic events of disseminated intravascular coagulation.

The nurse is caring for a child with leukemia. Which nursing intervention would be the highest priority for this child? encouraging the child to share feelings grouping nursing care following guidelines for reverse isolation providing age-appropriate activities

following guidelines for reverse isolation The child with leukemia is susceptible to infection, especially during chemotherapy. Infections such as meningitis, septicemia, and pneumonia are the most common causes of death. To protect the child from infectious organisms, follow standard guidelines for reverse isolation. Grouping nursing care to provide rest is important, but not the highest priority. Encouraging the child to share feelings and providing age-appropriate activities are important, but psychological issues are a lower priority than physical.

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

giving ferrous sulfate with orange juice between meals Treatment for iron-deficiency anemia is the administration of ferrous sulfate for a 13-year-old client with a hemoglobin at 11 g/dL (110 g/L). It should be administered with orange juice, because vitamin C helps absorb iron. It should not be taken with milk. It can cause teeth staining in children and should be given with a straw. Intravenous immunoglobulin would be administered for idiopathic thrombocytopenic purpura. The client's hemoglobin level is not severe enough to warrant blood transfusions at this time. There is also no indication the child is symptomatic. Anemia is generally diagnosed for a hemoglobin less than 12 g/dL (120 g/L) in children 12 to 14 years of age. The normal level for children 12 to 18 years of age is 14 g/dL (140 g/L). While increasing fresh fruits and vegetables is good for the client's overall health, this client needs foods specifically high in iron. These include broccoli, bananas, tomatoes, spinach, liver, nuts, dates, legumes, beef, eggs, and pork.

The nurse is caring for a 4-year-old child following surgical removal of a stage I neuroblastoma. Which intervention is appropriate for this child? applying aloe vera to the postsurgical site to promote healing administering antiemetics as prescribed for nausea giving medications as prescribed via the least invasive route maintaining isolation as prescribed to avoid infection

giving medications as prescribed via the least invasive route Giving medications as prescribed using the least invasive route is a postsurgery intervention focused on providing atraumatic care and is appropriate for this child. Because the child had a stage I tumor that was treated by surgical removal, the child does not require chemotherapy or radiation therapy. Therefore, the nurse need not apply aloe vera lotion, which is used for skin care following radiation therapy. Similarly, the nurse need not administer antiemetics nor maintain isolation, which are interventions used to treat side effects of chemotherapy.

A 4-year-old child has developed acute lymphoblastic leukemia (ALL). Nursing care for the child with ALL involves taking axillary, rather than rectal, temperatures because the child: is anemic. has a low white blood cell count. has a low platelet count. is prone to diarrhea.

has a low platelet count. In ALL, the bone marrow becomes unable to maintain the normal levels of red blood cells, white blood cells, and platelets. Children with ALL bruise and bleed easily. If a rectal thermometer is inserted it can cause bleeding from the irritation of the mucosal membrane because of the decreased platelet count. Using a rectal thermometer also is invasive so there is a large possibility of introducing microorganisms to the child. This could be damaging to the child if the child is neutropenic and has no immune defenses. The child may be prone to diarrhea because of the chemotherapy drugs but that is not the primary reason for not using the rectal temperature. Nursing care for the child should also be provided in the least invasive manner possible. That means not using any IM or SQ injections.

A school nurse is teaching a group of parents about signs and symptoms of cancer in children. Which symptom is an early sign of a brain tumor? headache, vision changes, and vomiting projectile vomiting, lethargy, and coma headache, epistaxis, and dizziness nystagmus, ataxia, and seizures

headache, vision changes, and vomiting Children with any form of brain tumor develop symptoms of increased intracranial pressure: headache, vision changes, vomiting, an enlarging head circumference, or papilledema. Lethargy, projectile vomiting, and coma are late signs. Epistaxis is not usually related to a brain tumor. A growing tumor produces specific localized signs, such as nystagmus (constant horizontal movement of the eye) or visual field defects. As tumor growth continues, symptoms of ataxia, personality change (e.g., emotional lability, irritability), and seizures may occur. These would be later symptoms.

A 12-year-old child is admitted to the hospital with a diagnosis of sickle cell crisis. The nurse has completed an assessment and is creating a plan of care. What aspect of the plan of care is mostimportant to the client's outcome? age-appropriate distractions as a pain-relief strategy increasing the daily fluid intake analgesics administered on a set schedule instead of as needed maintain the hemoglobin level at 10 g/dL (100 g/L)

increasing the daily fluid intake Hydration is paramount to resolving a sickle cell crisis. Administering analgesics on a set schedule versus an as-needed schedule will help keep the pain at a manageable level. The hemoglobin level during a crisis can be as low as 6 g/dL (60 g/L). To get to 10 g/dL (100 g/L), the client would need to be transfused. Using age-appropriate distractions as pain relief may not be effective during a crisis initially.

A child with acute lymphoblastic leukemia (ALL) is starting treatment with methotrexate in an attempt to eradicate the leukemic cells. Which stage of therapy is the child undergoing? induction stage sanctuary stage consolidation stage delayed intensive-therapy stage

induction stage A chemotherapy program is first aimed at achieving a complete remission or absence of leukemia cells (induction phase); second, preventing leukemia cells from invading or growing in the CNS (sanctuary or consolidation phase); third, administering delayed intensive therapy; and fourth, maintaining the original remission (maintenance phase).

A nurse is caring for a child with Hodgkin disease who is in the induction phase of a chemotherapy regimen. The nurse explains to the parents that the goal of this phase is to: destroy any remaining cancer cells. kill enough cancerous cells to induce remission. destroy any residual cancer cells. follow up for recurrent disease or late effects.

kill enough cancerous cells to induce remission. During induction, the initial phase, intensive therapy is given to kill enough cancerous cells to induce a remission. In the consolidation phase, intensive therapy is given to destroy remaining cancer cells. The maintenance phase is a designated period during which treatment is continued to destroy any residual cancer cells. During the observation phase, therapy has ended and the child is followed up for recurrent disease or late effects of treatment.

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)? joint pain and swelling anorexia and weight loss abdominal pain, nausea, and vomiting lethargy, bruises, and lymphadenopathy

lethargy, bruises, and lymphadenopathy Although all of these symptoms could be related to leukemia, the most likely are lethargy, bruises, and lymphadenopathy. Joint pain and swelling could also be juvenile arthritis or another disorder. Anorexia and weight loss are fairly nonspecific, as is abdominal pain, nausea, and vomiting. With ALL, because the bone marrow overproduces lymphocytes and therefore is unable to continue normal production of other blood components, the first symptoms of ALL in children usually are those associated with decreased RBC production (anemia) such as pallor, low-grade fever, and lethargy. A low thrombocyte (platelet) count will lead to petechiae and bleeding from oral mucous membranes and cause easy bruising on arms and legs. As the spleen and liver begin to enlarge from infiltration of abnormal cells, abdominal pain, vomiting, and anorexia occur. As abnormal lymphocytes invade the bone periosteum, the child experiences bone and joint pain. Central nervous system (CNS) invasion leads to symptoms such as headache or unsteady gait. On physical assessment, painless, generalized swelling of lymph nodes is revealed.

Children with acute lymphoblastic leukemia (ALL) may need periodic lumbar punctures. The nurse would teach the parent that this is done to assess for: platelets. leukemic cells. early meningitis. early development of septicemia.

leukemic cells. Acute lymphoblastic leukemia (ALL) is a rapidly progressive cancer affecting the undifferentiated or immature cells. It is the most common form of cancer in children. Throughout the course of the disease and treatment the child will be tested regularly for complete blood counts, bone marrow aspirations, lumbar punctures, and testing for renal and liver function. Lumbar punctures are performed to determine if leukemic cells have infiltrated the central nervous system. The white blood cells, temperature, and other symptoms would be indicative of meningitis and septicemia. The platelet count would be assessed for the possibility of bleeding.

The nurse is evaluating the complete blood count of a 7-year-old child with a suspected hematological disorder. Which finding is associated with an elevated mean corpuscular volume (MCV)? macrocytic red blood cells (RBCs) decreased white blood cells (WBCs) platelet count of 250,000 hemoglobin (Hgb) of 11.2 g/dl (112 g/L)

macrocytic red blood cells (RBCs) When the MCV is elevated, the RBCs are larger and referred to as macrocytic. The WBC count does not affect the MCV. The platelet count and Hgb are within normal ranges for a 7-year-old child.

When planning the care for a child with leukemia who is receiving methotrexate, the nurse would assess the child closely for which possible effect? mucositis cushingoid facial appearance weight gain paresthesias of the fingers

mucositis Mucositis, or ulcers of the gum line and mucous membranes of the mouth, is a frequent side effect of methotrexate. Cushingoid facial appearance and weight gain are associated with the use of prednisone. Paresthesias are associated with vincristine.

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

opioids Chronic or terminal pain may be managed in the home with continuous administration of opioids, orally or intravenously, as a bolus injection or infusion. Both pharmacologic and nonpharmacologic interventions are important in managing pediatric pain. Mild analgesics, topical anesthetics, and opioids can be used to treat pain. Sedatives such as midazolam or anesthetic medications such as ketamine or propofol may be used to assist children undergoing painful procedures that are required routinely during their cancer treatment.

The nurse is reviewing the medical record of a child diagnosed with Hodgkin lymphoma at the asymptomatic stage. Which would the nurse identify as typically the first sign reported by the child? painless, enlarged lymph node anorexia weight loss night sweats

painless, enlarged lymph node Children with Hodgkin lymphoma typically present with swollen, painless, and rubbery-feeling lymph nodes in the cervical or supraclavicular region. Depending on the extent of the disease at diagnosis, other symptoms may be present. However, this child was diagnosed in stage I (asymptomatic). If the lymph nodes of the chest are involved, the child has moved to the symptomatic stages and may experience dyspnea and cough. Chest pain may result from the pressure exerted by the enlarged nodes. General symptoms can also include fever, drenching night sweats, and weight loss.

The nurse is assessing a child and notices pinpoint hemorrhages appearing on several different areas of the body. The hemorrhages do not blanch on pressure. The nurse documents this finding as: petechiae. purpura. ecchymosis. poikilocytosis.

petechiae Petechiae are pinpoint hemorrhages that occur anywhere on the body and do not blanch with pressure. Purpura are larger areas of hemorrhage in which blood collects under the tissues and appear purple in color. Ecchymosis refers to areas of bruising. Poikilocytosis refers to the variation in the size and shape of the red blood cells commonly found in children with thalassemia.

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

red meat, eggs, oatmeal, and dried fruit Iron-deficiency anemia occurs when the blood does not have enough iron to produce hemoglobin. The anemia can be corrected via iron supplementation, nutrition, and even blood transfusion if the anemia is severe. Foods that have the highest sources of iron include red meat, tuna, eggs, tofu, enriched grains, dried beans and peas, dried fruits, green leafy vegetables and iron-fortified breakfast cereals. The nurse should teach the meal containing red meat, eggs, oatmeal, and dried fruit has the highest amount of iron. Chicken has less iron than red meat, and corn has only a small amount. All the fruits listed have iron, but when dried, the iron levels increase. Pork has a limited amount of iron, and white rice contains almost no iron. Brown rice and whole grains contain higher iron amounts.

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? bradycardia and distinct S1 and S2 sounds wheezing and diminished breath sounds respiratory distress and poor perfusion tachycardia and respiratory distress

tachycardia and respiratory distress Increased heart rate, murmur, and respiratory distress are symptoms of hyperleukocytosis (high white blood cell count) which is associated with leukemia. Increased heart rate and blood pressure are indicative of tumor lysis syndrome, which may occur with acute lymphoblastic leukemia, lymphoma, and neuroblastoma. Wheezing and diminished breath sounds are signs of superior vena cava syndrome related to non-Hodgkin's lymphoma or neuroblastoma. Respiratory distress and poor perfusion are symptoms of massive hepatomegaly which is caused by a neuroblastoma filling a large portion of the abdominal cavity.

The nurse is teaching the parents of a 15-year-old boy who is being treated for acute myeloid leukemia about the side effects of chemotherapy. For which symptoms should the parents seek medical care immediately? earache, stiff neck, or sore throat blisters, ulcers, or a rash appear temperature of 101°F (38.3°C) or greater difficulty or pain when swallowing

temperature of 101°F (38.3°C) or greater The parents should seek medical care immediately if the child has a temperature of 101°F (38.3° C) or greater. This is because many chemotherapeutic drugs cause bone marrow suppression; the parents must be directed to take action at the first sign of infection in order to prevent overwhelming sepsis. The appearance of earache, stiff neck, sore throat, blisters, ulcers, or rashes (or difficulty/pain when swallowing) are reasons to seek medical care, but are not as grave as the risk of infection.

A child diagnosed with beta-thalassemia presents with the classic findings of hyperbilirubinemia, splenomegaly, hepatomegaly, delayed growth and sexual maturation, and abnormal facial appearance. What category of the disease do these symptoms represent? thalassemia intermedia thalassemia minor thalassemia minima thalassemia major

thalassemia major Thalassemia is an inherited disorder causing a decreased production of normal hemoglobin. Thalassemia is classified in three categories according to the severity of the disease. In thalassemia minor, microcytic anemia is present but no treatment is required. In thalassemia intermedia, the child has significantly more problems and will require routine blood transfusions to correct the anemia. In thalassemia major, the child is very ill and will need ongoing medical care, blood transfusions and chelation therapy. Thalassemia is usually diagnosed by 1 year of age. The child has pallor, jaundice, hepatosplenomegaly, growth retardation, and failure to thrive. The nurse should assess for bony deformities and frontal bossing. There is no thalassemia minima.

In caring for a child with sickle cell disease, the highest priority goal is: the caregiver's anxiety will be reduced. the child's skin integrity will be maintained. the family will verbalize understanding of the disease crisis. the child's fluid intake will improve.

the child's fluid intake will improve. The highest priority goals for this child are maintaining comfort and relieving pain. The child is prone to dehydration because of the kidneys' inability to concentrate urine, so increasing fluid intake is the next highest priority. Other goals include improving physical mobility, maintaining skin integrity, reducing the caregiver's anxiety, and increasing the caregiver's knowledge about the causes of crisis episodes — but these goals are not the highest priority.

The oncology nurse is alert for clients displaying signs and symptoms of disseminated intravascular coagulation (DIC). Which symptom would alert the nurse to this emergency condition? uncontrolled bleeding platelet count 10,000/mm3 (10 ×109/L) decreased D-dimer assay increased antithrombin III levels

uncontrolled bleeding DIC is a complex condition that is secondary to other problems such as sepsis. It is life-threatening. Symptoms of DIC include uncontrolled bleeding, petechiae, ecchymosis, purpuric rash, prolonged prothrombin time and partial thromboplastin time, an increased D-dimer assay, decreased antithrombin III levels, below-normal fibrinogen levels, and increased fibrin-degradation products. The platelet count is decreased in DIC. In moderate to severe cases it is less than 50,000/mm3 (50 ×109/L). The symptom the nurse would see first is uncontrolled bleeding. The remainder are laboratory results that would be used to make the diagnosis.

A 14-year-old girl who is a vegetarian has recently developed anemia. Blood smear results show large, fragile, immature erythrocytes. She claims to take an iron supplement regularly and is surprised to learn that she is anemic, as she is otherwise healthy. As the nurse considers all of the data in the case, which anemia will the nurse discuss when collaborating with the primary healthcare provider? vitamin B12 deficiency iron deficiency sickle-cell disorder acute blood loss

vitamin B12 deficiency Vitamin B12 is necessary for the maturation of RBCs. Pernicious anemia results from deficiency or inability to use the vitamin, resulting in RBCs that appear abnormally large and are immature megaloblasts (nucleated immature red cells). Thus, pernicious anemia is one of the megaloblastic anemias. In children, the cause is more often lack of ingestion of vitamin B12 rather than poor absorption. Adolescents may be deficient in vitamin B12 if they have a long-term, poorly formulated vegetarian diet, as the vitamin is found primarily in foods of animal origin. Since the client is taking iron, iron deficiency anemia is ruled out. The blood cells in a client with sickle cell anemia are crescent-shaped and do not display the characteristics noted. There are no symptoms of blood loss or acute bleeding, as the client is otherwise healthy.

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? hydroxyurea orally ferrous sulfate daily folic acid supplement vitamin B12 injections

vitamin B12 injections Children with pernicious anemia have a vitamin B12 deficiency and have symptoms such as pallor, irritability, beefy red tongue, and diarrhea. Children with iron-deficiency anemia require ferrous sulfate. Folic acid is needed for children with macrocytic anemia. Hydroxyurea could be prescribed for a child with sickle cell anemia.