Unit 11 Questions pediatric nursing

When performing a physical examination on a client with cirrhosis, a nurse notices that the client's abdomen is enlarged. Which of the following interventions should the nurse consider?

Measure abdominal girth according to a set routine.

What are neutropenic precautions?

private room door closed handwashing no gowns or gloves no fresh fruits or vegetbles or flowers in the room No sick people in the room No special precautions when leaving the room.

A client is being admitted for mild neutropenia and a severe oral monilial infection. The nurse should assign the child to which room? 1. A semi-private room with a medical client. 2. A semi-private room with a surgical client. 3. A private room without further precautions. 4. A private room with protective isolation.

A private room without further precautions. A private room assignment is indicated for children with chemotherapy-related neutropenia. Careful handwashing is also an essential element to reduce the risk of infection.

A client with hepatic cirrhosis questions the nurse about the possible use of an herbal supplement—milk thistle—to help heal the liver. Which is the most appropriate response by the nurse?

"Silymarin from milk thistle has anti-inflammatory and antioxidant properties that may have beneficial effects, especially in hepatitis. However, you should always notify your primary care provider of any herbal remedies being used so drug interactions can be evaluated."

A client is to begin radiation therapy after the removal of Wilms' tumor. The parent statement that indicates a lack of understanding of related skincare would be: 1. "We will use loose-fitting clothes on our child." 2. "We will protect our child from sun exposure." 3. "We will keep the area moist with Vaseline." 4. "We will prevent our child from scratching the site."

"We will keep the area moist with Vaseline." Self-care during external radiation therapy includes loose-fitting clothes, gentle washing with mild soap, avoiding sun exposure, and avoiding scratching and other irritation. Any lubricant must be water-soluble.

A patient is being cared for by a home health nurse. The patient has jaundice and is complaining of puritis. Which of the following interventions can the nurse implement to reduce puritis? (Select all that apply) 1. Maintain a cool house temperature 2. Use antibacterial soap to remove dead skin 3. Use tepid water for bathing 4. Wear tight clothing

1,3: To reduce puritis related to bile salt accumulation, the patient should keep the house cool, use tepid (cool or lukewarm) water for bathing, avoid harsh soaps and detergents, and take antihistamines.

What dietary changes are necessary for a patient with esophageal varicies? 1. Administer naturally soft foods such as yogurt 2. Administer food high in protein such as nuts 3. Administer food low in protein such as fruit 4. Administer food high in roughage to promote GI motility

1. Administer soft foods such as yogurt A soft diet eliminates foods that are difficult to chew or swallow, and in the case of esophageal varices, foods that may further irritate the esophagus. It includes foods that are naturally soft, such as yogurt or ripe bananas, and foods that are made soft by cooking, mashing or chopping, such as potatoes. You should also avoid foods that may tear the veins in your esophagus, such as taco shells, tortilla chips, hard vegetables such as carrot sticks or large pieces of raw fruit.

The mother of a child receiving chemotherapy asks the nurse why they are giving the child more than one drug at a time. The mother states this is why her child is so sick and it would be better to give the series one drug at a time. The nurse explains to the mother that using protocols of combination drugs: 1. Allow for a better kill of cancer cells. 2. Prevents renal damage. 3. Helps the child to get over the nausea faster. 4. Is a more efficient use of the nurse's time.

1. Allow for a better kill of cancer cells. Using multiple chemotherapeutic agents with different modes of actions allows for the greatest amount of cell destruction. Using multiple drugs does not prevent renal damage, reduce nausea, or allow for efficient use of nursing time.

A 3-year-old girl undergoing radiation therapy for a neoplasm states she is afraid of the large machines in the radiation department. To calm the child during the procedure, the nurse could: . Allow the child to keep a favorite stuffed animal with her during the therapy. 2. Stay with her during the therapy. 3. Allow a parent to stay with her during therapy. 4. Encourage her to think about a favorite place during the therapy.

1. Allow the child to keep a favorite stuffed animal with her during the therapy. Because of the danger of radiation, the child will be alone in the therapy room. Staff or parents cannot stay with the child. A 3-year-old is not old enough to use mental imaging when frightened. A favorite stuffed toy can provide comfort.

Appropriate interventions for a 2-year-old with nausea and vomiting related to chemotherapy would include: 1. Giving antiemetics at the start of treatment and on a fixed schedule rather than on demand. 2. Offering fluids in large amounts to combat dehydration. 3. Using foods with strong odors to stimulate appetite. 4. Assessing ability to drink independently.

1. Giving antiemetics at the start of treatment and on a fixed schedule rather than on demand. Using antiemetics regularly will help to manage nausea and vomiting. Foods that have strong odors will increase nausea and vomiting. Only small amounts of fluids should be offered. During periods of illness, children often regress to a "safer" period and regressive behaviors should be allowed if they comfort the child.

A patient with liver disease has been diagnosed with stage 2 hepatic encephalopathy. The nurse expects to assess for (select all that apply) 1. Hand tremors 2. Positive clonus 3. Increased metabolic rate 4. Stomatitis

1. Hand Tremors, 2. Clonus Asterixis is a tremor of the hand when the wrist is extended and is associated with metabolic encephalopathy. Clonus is often present as the neurological dysfunction progresses to a coma. Later in the progression towards comatose, deep tendon reflexes and clonus will be absent.

A child with leukemia develops oral stomatitis secondary to chemotherapy treatments. Nursing assessments related to this condition should focus on: 1. Hydration status. 2. Vitamin C intake. 3. Condition of teeth. 4. Handwashing techniques.

1. Hydration status. Stomatitis may cause the child to refuse fluids and foods. Hydration status would be an appropriate assessment to monitor the child's condition. Vitamin C intake would be important in healing the mucous membranes but not as important as hydration. The condition of the teeth is not involved in stomatitis.

A nurse is administering a chemotherapy drug to a patient via central line when the intravenous bag slips and breaks open, spilling the chemotherapy agent on the tile floor. The nurse should: 1. Remove all people from the room until the spill has been cleaned up. 2. Clean up the spill quickly to avoid inhaling fumes from the chemotherapy agent. 3. Use only material that can be washed to clean up the spill. 4. Call housekeeping immediately then proceed with routine nursing care.

1. Remove all people from the room until the spill has been cleaned up. The chemotherapy agent poses a risk to all individuals including the child who was to have received the drug. Removal of individuals from the area reduces the risk of inadvertent exposure. Care is taken to avoid inhalation of the fumes, but the procedure would involve activities to avoid aeration of the chemical not speed in clean up. Disposable cleanup materials are included in a spill kit.

The nurse is preparing a care plan for a client with hepatic cirrhosis. Which nursing diagnoses are appropriate? Select all that apply. Altered nutrition, more than body requirements, related to decreased activity and bed rest 1. Risk for injury related to altered clotting mechanisms 2. Activity intolerance related to fatigue, general debility, muscle wasting, and discomfort 3. Urinary incontinence related to general debility and muscle wasting 4. Disturbed body image related to changes in appearance, sexual dysfunction, and role function 5.Altered nutrition, more than body requirements, related to decreased activity and bed rest

1. Risk for injury related to altered clotting mechanisms 2. Activity intolerance related to fatigue, general debility, muscle wasting, and discomfort 4. Disturbed body image related to changes in appearance, sexual dysfunction, and role function

Ammonia, the major etiologic factor in the development of encephalopathy, inhibits neurotransmission. Increased levels of ammonia are damaging to the body. The largest source of ammonia is from: 1. The digestion of dietary and blood proteins. 2. Excessive diuresis and dehydration. 3. Severe infections and high fevers. 4. Excess potassium loss subsequent to prolonged use of diuretics.

1. The digestion of dietary and blood proteins.

Nursing considerations for hemorrhagic cystitis, which may occur with the use of cyclophosphamide (Cytoxan), include: 1. The use of antibiotics. 2. Emptying the bladder frequently. 3. Restricting fluids. 4. Planning for anaphylaxis.

2. Emptying the bladder frequently. One of the side effects of cyclophosphamide is hemorrhagic cystitis not anaphylaxis. Appropriate interventions include using Mesna to counteract the irritating nature of Cytoxan, forcing fluids, and having the client empty the bladder frequently.

The nurse is completing an assessment on a patient with cirrhosis. Which of the following nursing assessment is important to notify the physician? 1. Hematocrit of 37% and Hemoglobin of 12g/dl 2. Expanding ecchymosis 3. Red scratch marks on skin 4. Ascites and serum albumin of 3.4g/dl

2. Expanding ecchymosis Clients with cirrhosis have thrombocytopenia and vitamin K deficiency. Expanding bruises could be a sign of bleeding.

• A patient admitted with esophageal varicies has been found to have cirrhosis secondary to alcoholism. Which other manifestations of cirrhosis might the nurse expect to assess? (Select all that apply) 1. Increased serum albumin 2. Palmar erythema 3. Thiamine and magnesium deficiency 4. Elevated bilirubin levels

2. Palmar erythema, 3. magnesium and thiamine deficiency, 4. elevated bilirubin Cirrhosis manifestations (among others):Palmar erythema along with spider angioma and feminization of men r/t abnormal hormone regulation. Magnesium, thiamine, and vitamin deficiencies r/t alcoholism. Decreased levels of albumin r/t decreased production in the liver. Elevated bilirubin and presence of jaundice r/t decreased ability to conjugate bilirubin.

A child is admitted to the hospital with a diagnosis of leukemia. Presenting lab values show low numbers of platelets and red blood cells. A very high white blood cell (WBC) count is also noted. An appropriate nursing diagnosis related to these findings would include: 1. Infection. 2. Risk for impaired gas exchange. 3. Altered nutrition: Less than body requirements. 4. Fluid volume deficit.

2. Risk for impaired gas exchange. Low red blood cell count limits the ability of the blood to carry enough oxygen to meet tissue needs, making risk for impaired gas exchange the correct diagnosis. Infection is not a nursing diagnosis, although risk for infection would be an appropriate nursing diagnosis for this client. The high WBC count doesn't indicate infection but indicates disease process. Since the WBCs are immature, they would be unable to fight an infection appropriately. The deficiencies aren't related to inadequate nutritional intake. The volume of blood is adequate; rather, it's the cell count that is abnormal.

A teenage girl receiving chemotherapy has a nursing diagnosis of Body Image Disturbance. Nursing interventions to promote a positive body image would include: 1. Placing pictures of the girl before chemotherapy around the room to remind her of what she really looks like. 2. Pointing out teenage girls who have less hair than she does. 3. Holding a beauty day with a cosmetician to teach her how to put on makeup. 4. Having a chaplain talk to the girl about inner beauty.

3. Holding a beauty day with a cosmetician to teach her how to put on makeup. Hair loss, moon face and body obesity may all occur as a result of treatment with chemotherapeutic drugs. Placing pictures of the "old" girl around the room will only remind her of the changes that are occurring. Other girls with less hair will not be soothing to this girl's body image problems. Inner beauty is not a concern for the teenager who is concerned with her visible appearance. Learning appropriate make-up techniques will help her to counteract the changes that are occurring.

A child with neoplastic disease is in terminal condition. The child is receiving a large dose of morphine by continuous infusion for pain control. After the mother and nurse both reported to the physician that the child continues to be in severe pain, the physician has ordered a small increase in the morphine dosage. The nurse should: 1. Refuse to administer the drug because the child may develop tolerance to the dose. 2. Stop the infusion until another physician can check the order. 3. Increase the dose as prescribed. 4. Maintain the drug at the previous level and report the doctor for drug misuse.

3. Increase the dose as prescribed. There is no maximum dose of morphine. Increasing the dose in small increments is appropriate to control the pain. Addiction is not an issue as the child is terminal. Stopping the infusion will put the child into withdrawal, which could be fatal. The physician is not misusing a narcotic.

In planning care for a 4-year-old with anemia secondary to chemotherapy and radiation therapy, the nurse would include: 1. Frequent play periods. 2. A diet focused on food preferences. 3. Interviewing parents about the child's functional health patterns. 4. Allowing the child to plan daily activities.

3. Interviewing parents about the child's functional health patterns. Assessing this child will give baseline data to plan and evaluate care. Activity intolerance will be likely, so rest is important. This child is also too young to make choices about planning schedules and is likely to choose favorite foods that do not meet his nutritional needs. The caregiver should be educated in planning activities and making food choices.

The nurse is caring for a client who has ascites as a result of hepatic dysfunction. What intervention can the nurse provide to determine if the ascites is increasing? Select all that apply. 1. Measure urine output every 8 hours. 2. Assess and document vital signs every 4 hours. 3. Measure abdominal girth daily. 4. Perform daily weights. 5. Monitor number of bowel movements per day.

3. Measure abdominal girth daily. 4. Perform daily weights. 1. Measure urine output every 8 hours.

During rounds, the interdisciplinary team is discussing a child with leukemia who has just been diagnosed as terminal. The nurses describe the mother's behavior as angry, claiming the nurses are not providing care for her child. The team leader will focus on the probable cause of the mother's anger, which is: 1. Poor care on the part of the nurses. 2. Lack of attention for the mother's needs. 3. Overwhelming guilt for having caused leukemia. 4. A stage of bereavement over the anticipated loss of the child.

4. A stage of bereavement over the anticipated loss of the child. The stages of grief and bereavement include denial, anger, bargaining, depression, and acceptance. The anger expressed may often be displaced and directed towards persons who have a role in the loss. Nursing and other healthcare personnel must be aware of this in order to help the family cope with the impending loss.

• The nurse caring for a patient with portal hypertension notes the following to be related to portal hypertension, except: 1. Enlarged spleen 2. Ascities 3. Esophageal varicies 4. Elevated blood pressure

4. Elevated BP Portal hypertension causes hypertension in the portal vein and system, not elevated blood pressure in general. The hypertension of the portal vein leads to back up causing enlarged spleen, ascities, and esophageal varicies.

A child with leukemia has developed pancytopenia. Measures designed to reduce stomatitis in this child while receiving chemotherapy would include: 1. Alcohol-based mouthwash to reduce oral organisms. 2. Brushing the teeth twice a day with a firm-bristled toothbrush. 3. Increasing intake of citrus juices, such as orange juice, that contain vitamin C. 4. Rinsing the mouth several times a day with plain water.

4. Rinsing the mouth several times a day with plain water. Studies have shown that simply rinsing the mouth with water decreases the onset of stomatitis in chemotherapy patients. Alcohol -based mouthwash would be avoided as it is drying to the oral mucous membranes. A stiff toothbrush may cause the gums to bleed. Should oral lesions be present, acidic foods and liquids will increase discomfort.

What is the treatment for GVHD?

Corticosteroids such as prednisone Steroid skin cream Immunosuppressive medications such as methotrexate or cyclosporine

Spontaneous bacterial peritonitis (SBP) is defined as the infection of ascitic fluid without a contiguous source of intra-abdominal infection (eg, intra-abdominal abscesses, intestinal perforation) and in the absence of intra-abdominal focus of inflammation; cholecystitis or acute pancreatitis. SBP is one of the most frequent and life-threatening complications of patients with cirrhosis. • In monitoring for SBP, the nurse will assess for which of the following? (Select all that apply) 1. Fever 2. Diarrhea 3. Altered mental status 4. Paralytic Ileus

All of the above. • The most frequent symptoms associated with SBP are abdominal pain and/or tenderness, fever or new development of encephalopathy. In our study, the disturbing in mental state was the most common feature related to SBP (52%), followed by abdominal pain (24%) and fever (21%). Change in bowel movements is also described and diarrhea can herald SBP. The occurrence of paralytic ileus, hypotension, and hypothermia are always signs suggesting advanced infection and carries on a poor prognosis. The blood samples could reveal leukocytosis, acidosis, and the worsening of renal function.

What is the difference between an allogenic and autologous transplant?

Allogenic- from donor cells Autologous- from own cells

A child is receiving chemotherapy to induce remission in acute leukemia. When considering common side effects of chemotherapy, an appropriate nursing diagnosis early in the course of therapy would include: 1. Sleep disturbance. 2. Altered mucous membranes. 3. Risk for infection. 4. Risk for impaired tissue perfusion: peripheral.

Altered mucous membranes. Nausea and vomiting, anorexia, mouth sores, constipation, and pain are early and common side effects of chemotherapy. Bone marrow suppression reaches its peak 7 to 10 days after induction. Sleep disturbance may be related but is not directly caused by chemotherapy.

Why lactulose is the preferred treatment for patients hepatic disfunction

Ammonia is produced by bacterial enzymatic action on ingested amino acids in the bowel. Lactulose reverses the normal passage of ammonia from the colon to the blood and decreases the amount of ammonia absorbed from the colon, therefore reducing serum ammonia levels.

What are the priority nursing considerations for pancytopenia?

Anemia, infection, and risk for bleeding/injury

Why Neomycin?

Certain oral antibiotics can reduce urease-producing bacteria in the intestines, resulting in a decrease of ammonia production and absorption through the gastrointestinal tract.

A child is to receive chemotherapy intravenously with a vesicant drug. The nurse can ensure safe administration of this drug by: 1. Administering the drug using a positive pressure infusion pump. 2. Checking for blood return before, during and after administration of the drug. 3. Maintaining the infusion site below the level of the heart. 4. Delivering the infusion as rapidly as possible.

Checking for blood return before, during and after administration of the drug. By checking for blood return throughout the administration, the nurse can stop the infusion at any time a blood return does not occur. A positive pressure infusion pump, maintaining the infusion site below the level of the heart or rapid drug delivery does not guarantee the infusion does not extravasate.

Why "adequate" protein intake?

Dietary protein between 1.2-1.5g/kg is a normal dietary amount of protein. Studies show that restricting protein does not result in significant improvement or mortality reduction. Protein restriction should only be implemented after taking into account the patient's overall nutritional status.

You are assigned to the postoperative care of a client with a below-the-knee amputation for osteogenic sarcoma. Nursing care of the child would include: 1. Maintaining bedrest until able to use permanent prosthesis. 2. Keeping stump elevated continuously until prosthesis applied. 3. Applying a dressing to the stump that allows continuous visualization of the distal stump. 4. Encouraging early visits from friends.

Encouraging early visits from friends. Nursing care must be supportive of body image adjustment. The child would be encouraged to sit in a chair and ambulate on crutches while waiting for the permanent prosthesis. The stump dressing is a continuous ace bandage, which supports the stump shape in preparation for the prosthesis.

What is HLA matching?

Human leukocyte antigen (HLA) typing is used to match patients and donors for bone marrow or cord blood transplants. HLA are proteins -- or markers -- found on most cells in your body. Your immune system uses these markers to recognize which cells belong in your body and which do not. You have many HLA markers. Half are inherited from your mother and half from your father, so each brother and sister who shares the same parents as you has a 25% chance (1 in 4) of being a close HLA match. A close match between a donor's and a patient's HLA markers is essential for a successful transplant outcome. HLA matching promotes the growth and development of new healthy blood cells (engraftment) and reduces the risk of a post-transplant GVHD.

An adolescent on consolidation chemotherapy for acute lymphocytic leukemia (ALL) asks the nurse to come quickly to evaluate "blood in my urine." The nurse would do which of the following as the most important action? 1. Explain this is normal for these drugs. 2. Measure intake and output. 3. Force fluids to improve the hematuria. 4. Recognize that this is untoward and report the event.

Recognize that this is untoward and report the event. This is an untoward effect of the commonly used cancer medication cyclophosphamide (Cytoxan) and should be reported. Fluids are usually forced prior to administration and the bladder is emptied frequently to prevent hematuria. Measuring intake and output should be done routinely on all clients and is not specific to managing this complication.

What is pancytopenia?

Reduced WBC, RBC, and Platelet counts

ACUTE GVHD: Symptoms:

Skin rash - diffuse, blistering, burn-like Gastrointestinal (GI) tract effects - N/V, diarrhea, blood in stool, abdominal pain Liver: jaundice, tea colored urine, swelling in legs and abdomen

The nursing diagnosis for a child undergoing chemotherapy for leukemia is altered nutrition-less than body requirements related to nausea and anorexia. An appropriate goal for this client would be: 1. Administer antiemetics PRN. 2. The child's caloric intake will be within the normal range. 3. The child does not complain of nausea. 4. Intake and output are approximately equal.

The child's caloric intake will be within normal range. The client's goal is stated in terms of behaviors of the child that demonstrates the problem is solved. Option 1 is a nursing action, not a goal. Absence of nausea does not guarantee adequate intake. Equal intake and output does not indicate adequate nutrition.

A school-age child is being admitted for surgical removal of a brain tumor. Expected nursing assessments during the preoperative period would include: 1. Bulging fontanels. 2. Vomiting. 3. Elevated blood glucose levels. 4. Drainage from the ear or nose.

Vomiting. Vomiting is a symptom of increased intracranial pressure. Bulging fontanels would not be present in a school-age child. Drainage from the ear or nose might indicate a basilar skull fracture, not a brain tumor. Some brain tumors display the symptom of diabetes insipidus, not diabetes mellitus, thus the symptom would be dilute urine rather than elevated blood glucose.