#1 PEDS Ch 46 - Nursing Care of the Child With an Alteration in Cellular Regulation / Hematologic or Neoplastic Disorder

intravenous immune globulin (IVIG)

* given for Idiopathic thrombocytopenic purpura - IVIG simply provides extra antibodies that your body cannot make on its own. IVIG also provides a wide range of antibodies to help fill in for those your own immune system has not encountered.

Neutropenia

- Neutropenia is when a person has a low level of neutrophils. - Neutrophils are a type of white blood cell. - All white blood cells help the body fight infection. - Neutrophils fight infection by destroying harmful bacteria and fungi (yeast) that invade the body. - Neutrophils are made in the bone marrow.

signs of changes in hematologic system are often subtle and over looked. What are some of the first signs of a problem developing

- color changes in skin such as pallor, bruising and flushing - changes in mental status such as lethargy - decrease oxygenation to the brain

The nurse is caring for a 6 yr old with leukemia who is having an oncologic emergency. Which signs and symptoms of hyperleukocytosis? a. bradycardia and S1 S2 sounds b. weezing c. respiratory distress and poor perfusion d. tachycardia and respiratory distress

- increase HR -murmur and respiratory distress symptoms

The child has been diagnosed with leukemia. Rank the following medications used to treat leukemia in order based on the stage of treatment. 1 Oral steroids and vincristine through an intravenous line 2 High-dose methotrexate and 6-mercaptopurine 3 Chemotherapy through an intrathecal catheter 4 Low doses of 6-mercaptopurine and methotrexate

1, 2, 4, 3

according to the American Academy of Pediatric, what is the recommended action for blood lead level of 20 to 44 mg/dL?

1. confirm the level with a repeat lab within 1 week 2. educate family to decrease lead exposure

An adolescent weighing 55 kg is admitted to the hospital experiencing a sickle cell crisis. Intravenous fluid therapy as well as increased oral fluids are ordered as part of his treatment plan. Based on the understanding of the amount of fluids needed to promote hemodilution, the nurse would expect the adolescent to receive how much total fluid in 24 hours? __________ mL

8,250

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

A

Children with ALL may need periodic lumbar punctures. You would teach the mother this is done to assess for: a) leukemic cells. b) early meningitis. c) platelets. d) early development of septicemia.

A

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? a) 150 mL/kg of fluids b) 110 mL/kg of fluids c) 130 mL/kg of fluids per day d) 120 mL/kg of fluids per day

A

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)? a) Macrocytic red blood cells (RBCs) b) Decreased white blood cells (WBCs) c) Platelet count of 250,000 d) Hemoglobin (Hgb) of 11.2 g/dL

A

The nurse is providing family education for the prevention or early recognition of vaso-occlusive events in sickle cell anemia. Which response by a family member indicates a need for further teaching? a) "We should call the doctor for any fever over 100°F." b) "We must watch for unusual headache, loss of feeling, or sudden weakness." c) "We must be compliant with vaccinations and prophylactic penicillin." d) "We need to seek medical attention for abdominal pain."

A

The nurse prepares to collect a 24-hour urine specimen for catecholamines from the child admitted with which likely childhood cancer diagnosis? a) Neuroblastoma b) Wilms tumor c) Retinoblastoma d) Osteogenic sarcoma

A

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

A

The pediatric nurse examines the radiographs of a client that show that there are lesions on the bone. This finding is indicative of: a) Ewing sarcoma. b) non-Hodgkin lymphoma. c) Hodgkin disease. d) neuroblastoma.

A

What would the nurse expect to be ordered for a child with acute lymphoblastic leukemia who develops tumor lysis syndrome? a) Allopurinol b) Dexamethasone c) Inotropics d) Leukapheresis

A

Hemophilia

A hereditary disease where blood does not coagulate to stop bleeding

The nurse is caring for a child with thalassemia who is receiving chelation therapy at home using a battery-operated pump. After teaching the parents about this treatment, which statement by the mother indicates a need for additional teaching? A) "I can have the nurse administer the chelation therapy if I am uncomfortable." B) "I must be very careful to strictly adhere to the chelation regimen." C) "The deferoxamine binds to the iron so it can be removed from the body." D) "The medication can be administered while my child is sleeping."

A) "I can have the nurse administer the chelation therapy if I am uncomfortable." *the nurse wont be leaving with them

he nurse is evaluating the laboratory test results of a 7-year-old child with a suspected hematologic disorder. Which finding is associated with an elevated mean corpuscular volume (MCV)? a. Macrocytic RBC b. decreased WBC C. platelet count 250,000 D. hemoglobin 11.2g

A. when MCV is elevated = enlargend RBC

A child with suspected sickle cell disease is scheduled for a hemoglobin electrophoresis. When reviewing the child's history, which of the following would the nurse identify as potentially interfering with the accuracy of the results? A) Use of iron supplementation B) Blood transfusion 1 month ago C) Lack of fasting for 12 hours D) History of recent infection

B) Blood transfusion 1 month ago

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

C

When reviewing information about the incidence of the various types of childhood cancer, nursing students demonstrate understanding of the information when they identify which type as having the highest incidence? a) Neuroblastoma b) Osteogenic sarcoma c) Acute lymphocytic (lymphoblastic) leukemia d) Non-Hodgkin's lymphoma

C

chelation therapy

Chelation therapy is a medical procedure that involves the administration of chelating agents to remove heavy metals from the body. can remove iron

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

D

Factor VIII

Hemophilia A * an essential blood-clotting protein, also known as anti-hemophilic factor (AHF)

thalassemia

Inherited defect in ability to produce hemoglobin

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

Temperature of 101° F (38.3° C) or greater because many chemotherapy drugs cause bone marrow suppression. Parent must take action at first sign of infection

anemia is the reduction of RBC or hemoglobin in the total blood ______

VOLUME

Beckwith-Wiedemann syndrome.

a growth disorder syndrome synonymous with enlargement of several organs including the skull, tongue, and liver

asplenia

absence of a spleen or of spleen function

the nurse is assessing a 14 yr with a tumor. which finding indicates Ewing sarcoma? a. child reports dull bone pain just below her knew b. palpation reveals swelling and redness on right ribs c. child reports persistent pain from minor ankle injury

b. Ewing sarcoma may result in swelling and erythema at the tumor site. -dull bone pain just below her knew ( osteosarcoma)

Granulocytes

basophils:produce histamine in response to allergic attack eosinophils:produce anti-histamine when the allergic reaction has overcomed. neutrophils: phagocytes which are included in 2nd line defense. They engulf and ingest bacteria rapidly

aplastic anemia

failure of blood cell production in the bone marrow

Thalassemia

inherited defect in ability to produce hemoglobin, leading to hypochromia * to much iron in them

spooning of nails

iron deficiency

the most frequently occurring type of childhood cancer?

leukimia

bone cancer may be treated with a combination of ______ procedure, radiation, and chemotherapy

limb salvage

penicillin is given for

prophylaxis of infection in asplenia

Ewing sarcoma

rare malignant tumor arising in bone; most often occurring in children

Deferoxamine

used to treat acute iron toxicity

Question: Nursing students are reviewing information about the normal cell cycle. They demonstrate understanding of this process when placing phases in the proper sequence. Place the phases in the sequence that demonstrates understanding by the nursing students. 1 Cell at rest 2 Cell division 3 Doubling of cell size 4 Period until DNA stabilization complete 5 Duplication of DNA and chromosomes 6 Gap

6, 1, 4, 5, 3, 2

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

A

In hemophilia A, the classic form, only females manifest a bleeding disorder. a) False b) True

A

The nurse is assessing a child with aplastic anemia. Which of the following would the nurse expect to assess? Select all that apply. A) Ecchymoses B) Tachycardia C) Guaiac-positive stool D) Epistaxis E) Severe pain F) Warm tender joints

A) Ecchymoses B) Tachycardia C) Guaiac-positive stool D) Epistaxis

When evaluating the hemogram of an 8-month-old infant, the nurse would identify which type of hemoglobin as being the predominant type? A) Hemoglobin A B) Hemoglobin F C) Hemoglobin A2 D) Hemoglobin S

A) Hemoglobin A *after 6 months of age hemoglobin A is the predominant type

The nurse is developing a plan of care for a child with thalassemia. Which of the following would the nurse expect to include? Select all that apply. A) Packed RBC transfusions B) Deferoxamine therapy C) Heparin therapy D) Opioid analgesics E) Platelet transfusions F) Intravenous immunoglobulin

A) Packed RBC transfusions B) Deferoxamine therapy

The nurse is conducting a physical examination of a toddler with suspected lead poisoning. Lab results indicate blood lead level 52 mg/dL. Which action would the nurse expect to happen next? A) Repeat testing within 2 days and prepare to begin chelation therapy as ordered B) Repeat testing within 1 week with education to decrease lead exposure C) Confirm with repeat testing in 1 month and referral to local health department D) Prepare to admit child to begin chelation therapy

A) Repeat testing within 2 days and prepare to begin chelation therapy as ordered

When providing care to a child with aplastic anemia, which nursing diagnosis most likely would be the priority? A) Risk for injury B) Imbalanced nutrition, less than body requirements C) Ineffective tissue perfusion D) Impaired gas exchange

A) Risk for injury

A nurse is leading a discussion with a group of new mothers about newborn nutrition and its importance for growth and development. One of the mothers asks, "Doesn't the baby get iron from me before birth?" Which response by the nurse would be most appropriate? A) "You give the baby some iron, but it is not enough to sustain him after birth." B) "Because the baby grows rapidly during the first months, he uses up what you gave him." C) "The iron you give him before birth is different from what he needs once he is born." D) "If the baby didn't use up what you gave him before birth, he excretes it soon after birth."

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

A nurse is teaching the parents of a child with sickle cell disease about factors that predispose the child to a sickle cell crisis. The nurse determines that the teaching was successful when the parents identify what as a factor? a) Pallor b) Fluid overload c) Infection d) Respiratory distress

C

The physician orders an alkylating agent for a child's chemotherapy. Which best describes an action produced by these types of agents? a) They damage cells by acting as a substitute for a natural metabolite in an important molecule. b) They are most active in the S phase and act similarly to normal cellular metabolites necessary for cell replication. c) They are cell cycle-nonspecific, destroying both resting and dividing cells. d) They are synthesized naturally by various bacterial and fungal agents.

C

The nurse is reviewing the white blood cell differential of a 4-year-old girl. Which value would lead the nurse to be concerned? A) Bands: 8% B) Segs: 28% C) Eosinophils: 10% D) Basophils: 0%

C) Eosinophils: 10%

A child on the pediatric unit has morning laboratory results of Hgb 10.0, Hct 30.2, WBC 24,000, and platelets 20,000. What is the priority nursing assessment? a. Assess for pallor, fatigue, and tachycardia. b. Monitor for fever. c. Assess for bruising or bleeding. d. Determine intake and output.

C. The extremely low platelet count places the child at significant risk for bleeding, so this takes priority over borderline anemia and possibility of infection.

A 10-month-old has been admitted to the hospital with severe hemolytic anemia and chronic hypoxia. The nurse notes icteral sclerae, jaundice of the skin, and frontal and maxillary bossing. The nurse interprets these findings as most likely indicating: a) hemophilia. b) von Willebrand disease. c) sickle cell anemia. d) β-Thalassemia major

D

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

D

A 14-year-old experiencing difficulty breathing is sent for a radiograph. The nurse knows that difficulty breathing may be indicative of: a) Retinoblastoma b) Tumor in the liver c) Lymphadenopathy d) Mediastinal mass

D

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? a) Assessing for signs of capillary leak syndrome b) Monitoring for complaints of bone pain c) Assessing the child's hydration status secondary to vomiting d) Monitoring for allergic reactions or anaphylaxis

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

D, E

A child with leukemia has the following AM laboratory results: Hgb 8.0, Hct 24.2, WBC 8,000, platelets 150,000. What is the priority nursing assessment? a. Monitor for fever. b. Assess for bruising or bleeding. c. Determine intake and output. D. Assess for pallor, fatigue, and tachycardia.

D. The Hgb and Hct indicate anemia, which results in fatigue, pallor, and tachycardia.

chelating agents

blood lead levels greater than 45

Clubbing is a sign of

chronic hypoxemia

Hemogram

complete blood count

Wilms tumor

malignant tumor of the kidney occurring in childhood

Mean Corpuscular Volume (MCV)

measure of average size of the RBC (Indicates the oxygen-carrying capacity of blood)

Agranulocytes

monocytes:similar to neutrophils. They destroy bacteria lymphocytes: B lymphocytes produce antibodies to attack specific viruses, bacteria, and other foreign invaders. T lymphocytes help to identify cells that require an immune response

three way how childhood cancer differs from adult cancer

1. most common sites of childhood cancer are blood, lymph,brain,bone,kidney,muscle. 2. environmental factors have a strong influence on the cause of adult cancers versus minimal influence on child cancer 3. childhood cancer are typically very responsive

A child with acute lymphocytic leukemia is given leucovorin, a folinic acid, after high-dose methotrexate therapy. It is important to administer this drug because leucovorin: a) prevents methotrexate that is not incorporated into leukemia cells from entering normal cells. b) helps methotrexate enter leukemia cells the same as insulin helps glucose enter cells. c) is an experimental drug to ensure resistance to infection during methotrexate therapy. d) will encourage bone marrow to build new cells after methotrexate therapy.

A

A nurse is assessing an 8-year-old child brought to the emergency department by his mother. The child has a history of sickle-cell anemia and reports acute back pain and joint pain. His mucous membranes are dry; skin turgor is poor. Capillary refill is slowed and nail beds are pale. The child is diagnosed with sickle-cell crisis. Which nursing diagnosis would the nurse most likely identify as a priority? a) Acute pain related to effects of sickling b) Ineffective coping related to chronic illness c) Deficient fluid volume related to clustering of sickled cells d) Ineffective peripheral tissue perfusion related to the effects of sickled cells

A

A nurse is caring for a 12-year-old girl who is recovering from surgery for removal of a brain tumor. Which intervention should the nurse implement to avoid increasing intracranial pressure? a) Regulate the rate of IV fluid infusions carefully b) Place a sterile towel under wet dressings c) Sponge the client's face d) Apply saline eye drops, as prescribed

A

A nurse is providing dietary interventions for a 5-year-old with an iron deficiency. Which response indicates a need for further teaching? a) "Red meat is a good option; he loves the hamburgers from the drive-thru." b) "I must encourage a variety of iron-rich foods that he likes." c) "He will enjoy tuna casserole and eggs." d) "There are many iron fortified cereals that he likes."

A

Iron-deficiency anemia could be virtually eliminated if all infants were breastfed and those infants who are formula-fed were fed iron-fortified formula for the full first year. a) True b) False

A

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

A

The child with thalassemia may be given which classification of medication to prevent one of the complications frequently seen with the treatment of this disorder? a) Iron-chelating drugs b) Factor VIII preparations c) Potassium supplements d) Vitamin supplements

A

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

A

A group of students are reviewing information about glucose-6-phosphate dehydrogenase (G6PD) deficiency. The students demonstrate understanding of the material when they identify this disorder as due to which of the following? A) X-linked recessive inheritance B) Deficiency in clotting factors C) An excess supply of iron D) Autosomal recessive inheritance

A) X-linked recessive inheritance

A nurse is preparing a presentation for a parent group on childhood cancers. As part of the presentation, the nurse plans to discuss rhabdomyosarcoma. What are some common sites where rhabdomyosarcoma occurs? Select all that apply. a) Extremities b) Neck c) Head d) Gastrointestinal tract e) Central nervous system

A, B, C

The nurse is assessing a 2-year-old girl whose parents noticed that one of her pupils appeared to be white. Which assessments should the nurse expect to find if the girl has retinoblastoma? Select all that apply. a) Parents report that the child has headaches. b) Observation confirms cat's eye reflex in pupil. c) Assessment discloses hyphema in one eye. d) History reveals strabismus. e) Observation of eyes reveals yellow discharge.

A, B, C, D *observation reveling a thick,yellow discharged discharge is typical of infectious disease

A nurse is teaching a school-aged child with iron-deficiency anemia and her parents about dietary measures to increase iron intake. The nurse determines that the teaching was successful when they state which food is high in iron? Select all that apply. a) Eggs b) Green leafy vegetables c) Milk d) Fortified cereal e) Citrus fruits

A, B, D

A 5-year-old boy is diagnosed with congenital aplastic anemia. Which symptom should the nurse expect in this child? Select all that apply. a) Easy bruising b) Fatigue c) Bradypnea d) Pallor e) Bradycardia f) Cyanosis

A, B, D, F

The nurse is working with a child who is in sickle cell crisis. Treatment and nursing care for this child includes which actions? Select all that apply. a) Maintaining fluid intake b) Administering oxygen c) Preventing injury and bleeding episodes d) Promoting exercise and activity e) Administering analgesics

A, B, E

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? Choose all that apply. a) Add high-fiber snacks such as popcorn and apples to the diet. b) Use a rectal suppository at the same time each day. c) Provide adequate private time in the bathroom. d) Increase gross motor activities such as family walks.

A, C, D

A child with leukemia received chemotherapy about 10 days ago. She presents today with a temperature of 100.4°F, an absolute neutrophil count of 500, and mild bleeding of the gums. What is the priority nursing intervention? a. Administer IV antibiotics as ordered. b. Provide vigorous oral care frequently with a firm toothbrush. c. Monitor pulse and blood pressure for changes. D. Administer packed red blood cell transfusion.

A. The neutropenic child must have IV antibiotics started as soon as possible in the event of fever to prevent overwhelming infection and sepsis.

The nurse is caring for a child who has just been admitted to the pediatric unit with sickle cell crisis. He is complaining that his right arm and leg hurt. What is the priority nursing intervention? a. Administer pain medication every 3 hours intravenously until pain is controlled. b. Perform passive range of motion of the arm and leg to maintain function. c. Try acetaminophen for pain first, moving up to opioids only if needed. d. Use narcotic analgesics and warm compresses as needed to control the pain.

A. The priority in a sickling crisis is to bring pain under control quickly as this brings the child relief; also, the significant stress resulting from pain can contribute to the further sickling of cells.

Idiopathic thrombocytopenic purpura

Antiplatelet antibodies

Mean Platelet Volume (MPV)

Assesses platelet volume and size

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. The nurse recognizes that this is the likely cause of this type of anemia: a) Sickle-cell disorder b) Vitamin B12 deficiency c) Acute blood loss d) Iron deficiency

B

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

B

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

B

A child with ALL is beginning treatment with methotrexate in an attempt to eradicate the leukemic cells. The stage of therapy represents the: a) Sanctuary stage b) Induction stage c) Consolidation stage d) Delayed intensive-therapy stage

B

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

B

A toddler who is beginning to walk has fallen and hit his head on the corner of a low table. The caregiver has been unable to stop the bleeding and brings the child to the pediatric clinic. The nurse is gathering data during the admission process and notes several bruises and swollen joints. A diagnosis of hemophilia is confirmed. This child most likely has a deficiency of which blood factor? a) Factor XIII b) Factor VIII c) Factor X d) Factor V

B

During a physical examination of a 13-year-old boy, the nurse observes a single, enlarged, rubbery-feeling cervical lymph node in the armpit. The boy also reports unexplained loss of weight and malaise. Which condition should the nurse most suspect in this client? a) Acute lymphocytic leukemia (ALL) b) Hodgkin lymphoma c) Acute myeloid leukemia (AML) d) Non-Hodgkin lymphoma

B

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) "A family's economic problems are often a cause of malnutrition." b) "Milk is a perfect food, and babies should be able to have all the milk they want." c) "Children have a hard time getting enough iron from food during their first few years." d) "Caregivers sometimes don't understand the importance of iron and proper nutrition."

B

Parents tell the nurse who is admitting their infant for a well-child exam that they recently saw a "white glow" in their child's left pupil. What is the nurse's best response? a) "Has your baby been rubbing either eye?" b) "I will report this to the pediatrician." c) "Most parents mention a red color." d) "A plugged tear duct would not be unusual."

B

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

B

The nurse is caring for a 3-year-old boy with suspected iron-deficiency anemia. Which test would the nurse expect to be ordered to confirm the diagnosis? a) Hemoglobin electrophoresis b) Serum ferritin c) Iron test d) Reticulocyte count

B

The nurse is examining the hands of a child with suspected iron deficiency anemia. Which finding should the nurse expect? a) Pink palms and nail beds b) Spooning of nails c) Capillary refill in less than 2 seconds d) Absence of bruising

B

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

B

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? a) Using acetaminophen if the child needs an analgesic b) Calling the doctor if the child gets a sore throat c) Keeping a written copy of the treatment plan d) Writing down phone numbers and appointments

B

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

B

The nurse preparing clients for diagnostic testing for cancer knows that the following test is used to differentiate a neuroblastoma from other tumors: a) Serum chemistries b) Urine catecholamines VMA, HVA c) CBC with differential d) Urinalysis

B

The parents of a child with a bleeding disorder ask the nurse about appropriate activities and sports that they should encourage the child to participate in. What activity would be the safest for the nurse to suggest? a) Rugby b) Swimming c) Soccer d) Gymnastics

B

The primary intervention for beta-thalassemia is a chronic transfusion program of packed white blood cells with iron chelation. a) True b) False

B

The toddler with a cancer diagnosis is seen for a well-child checkup. Which health maintenance activity will the nurse exclude? a) Teaching the importance of taking water safety measures b) Administering the measles, mumps, rubella (MMR) vaccine c) Plotting height and weight on a growth chart d) Assessing dietary intake by addressing "picky eating" and "food jags"

B

What is a well-defined risk management technique that the nurse can teach children and parents to prevent cancer? a) Avoid artificial colors, flavors, and fragrances in foods, cosmetics, and household items b) Limit sun exposure throughout childhood and adolescence c) Eliminate aerosol sprays from the living area d) Incorporate more preservative-free foods into the diet

B

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

B

What is the best response by the nurse to the parents of a child with leukemia who express guilt because they did not take immediate action when their child seemed to develop one respiratory infection after another? a) "Young children develop minor illness easily and often. Stop being hard on yourselves." b) "Keep in mind that the signs of leukemia are often subtle and difficult to recognize." c) "You need to focus on the present treatment now and not worry about the past." d) "Don't feel bad. Children get lots of colds."

B

What is the priority action the nurse should take when caring for a child newly diagnosed with Wilms tumor (nephroblastoma)? a) Assess for constipation. b) Protect the abdomen from manipulation. c) Obtain a catheterized urine specimen. d) Control acute pain.

B

When explaining the procedure of bone marrow aspiration to a child with leukemia, what would be the best explanation? a) "You won't feel any pain at all, because you will be asleep." b) "You will feel pressure on your hip from the needle." c) "You will need to lie still afterward to prevent a headache." d) "You will have to lie on your back and hold your breath."

B

Which assessment below would increase your suspicion that iron-deficiency anemia may be present in a child? a) An 8-year-old girl is shy and does not participate in class b) A 15-year-old girl constantly sucks ice cubes c) A 7-month old boy does not say whole words yet d) A 3-month-old boy sucks his thumb

B

Which diagnosis would be most appropriate for an infant with a large retinoblastoma after surgery? a) Fear related to loss of normal vision b) Disturbed sensory perception related to enucleation c) Anticipatory grieving related to change in body image d) Pain related to retinal removal

B

The nurse is caring for a 12-year-old boy with idiopathic thrombocytopenia. The nurse is providing discharge instructions about home care and safety recommendations to the boy and his parents. Which response indicates a need for further teaching? A) "We should avoid aspirin and drugs like ibuprofen." B) "He can resume participation in football in 2 weeks." C) "Swimming would be a great activity." D) "Our son cannot take any antihistamines."

B) "He can resume participation in football in 2 weeks."

The nurse is assessing a child with suspected thalassemia. Which of the following would the nurse expect to assess? A) Dactylitis B) Frontal bossing C) Presence of clubbing D) Presence of spooning

B) Frontal bossing (prominent forehead)

A nurse is providing care to a child with idiopathic thrombocytopenic purpura with a platelet count of 18,000/mm3. Which medication would the nurse most likely expect to be ordered? A) Folic acid B) Intravenous immune globulin C) Dimercaprol D) Deferoxamine

B) Intravenous immune globulin * for children with platelet counts bellow 10,000 corticosteroids may be administered for 2 to 3 weeks * In acute or chronic ITP, Intravenous immune globulin may be used as an adjunct and is infused for 1 to 2 days

A child is prescribed monthly injections of vitamin B12. When developing the teaching plan for the family, the nurse would focus on which type of anemia? A) Aplastic anemia B) Pernicious anemia C) Folic acid anemia D) Sickle cell anemia

B) Pernicious anemia

The nurse is evaluating the laboratory test results of a 7-year-old child with a suspected hematologic disorder. Which finding would cause the nurse to be concerned? A) WBC: 5.6 × 103/mm3 B) RBC: 2.8 × 106/mm3 C) Hemoglobin: 11.4 mg/dL D) Hematocrit: 35%

B) RBC: 2.8 × 106/mm3

A child with iron-deficiency anemia is prescribed ferrous fumarate, 3 mg/kg/day in two divided doses. The nurse interprets this order as indicating which of the following? A) The child requires a prophylactic dose of iron. B) The child has mild to moderate iron deficiency. C) The child has severe iron deficiency. D) The child is being prepared for packed red blood cell administration.

B) The child has mild to moderate iron deficiency.

The mother of an 11-year-old girl who will begin radiation therapy soon asks the nurse what the family needs to do for their daughter during this time. Which interventions should the nurse mention? Select all that apply. a) Increase amounts of fresh fruit and vegetables rich in cellulose b) Expose the irradiated area to air c) Help the child devise "mind games" to play during the procedure d) Administer antiemetics as prescribed e) Apply skin creams and lotions to irradiated skin f) Encourage lengthy soaks in the bath

B, C, D

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

B, D, E

A nurse is assessing a child with cancer and suspects that the child has developed sepsis based on what findings? Select all that apply. a) Thrombocytosis b) Absolute neutrophil count (ANC) less than 500 c) Respiratory alkalosis d) Hyperkalemia e) Increased blood urea nitrogen (BUN)

B, D, E

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? a) Performing dressing changes to the affected area b) Preparing the child for amputation c) Avoiding further abdominal palpation d) Administering analgesics for pain

C

A 9-month-old boy with iron-deficiency anemia is given ferrous sulfate therapy. Which assessment would best help you determine that he is actually taking it daily? a) He will be less irritable than he was at his last visit. b) His reticulocyte count will have decreased. c) His stools will appear black. d) He will develop diarrhea.

C

A child undergoing chemotherapy for leukemia is receiving methotrexate as part of maintenance therapy. What would the nurse expect to be prescribed to assist in counteracting the effects of this drug? a) Prednisone b) Cisplatin c) Leucovorin d) Vincristine

C

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? a) Blood b) Brain c) Bladder d) Kidney

C

A high-school football player has been diagnosed as having osteosarcoma of the femur. His mother is angry because she told him not to play football. Which health teaching points would you include in the teaching plan for the boy and his mother? a) Tumor growth is more related to his dislike of milk. b) He can expect some discoloration of his leg following chemotherapy. c) Football injuries do not contribute to the development of a tumor. d) Osteosarcoma often follows trauma, such as a football injury.

C

A nurse caring for an 8-year-old with a bleeding disorder documents the following nursing diagnosis: ineffective tissue perfusion related to intravascular thrombosis and hemorrhage. This diagnosis is most appropriate for a client with: a) Hemophilia b) von Willebrand disease c) Disseminated intravascular coagulation d) Iron deficiency anemia

C

A school-aged child is admitted to the hospital with a vaso-occlusive sickle cell crisis. Which measure in his care should be given priority? a) Encouraging him to take deep breaths hourly b) Beginning active range-of-motion exercises c) Maintaining a fluid intravenous line d) Seeing that he ingests a protein-rich diet

C

A teenage girl asks why chemotherapy causes hair loss. Which response by the nurse is accurate? a) Hair is exposed to the sun, which increases sensitivity to chemotherapy. b) Circulation to the head causes large doses of chemotherapy to reach the scalp. c) Chemotherapy affects cancer cells and normal cells that multiply rapidly. d) Hair is not a living tissue, and it is easily damaged by chemotherapy.

C

After teaching the parents of a child diagnosed with pernicious anemia about the disorder and treatment, the nurse determines that the teaching was successful when the parents state: a) "He needs to eat more green leafy vegetables to cure the anemia." b) "We'll need to plan for a bone marrow transplant soon." c) "He'll need to have those vitamin shots for the rest of his life." d) "He might get constipated from the supplement."

C

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

C

How can the nurse most simply describe for distressed parents a rhabdomyosarcoma that has been found in their 5-year-old? a) Indicate that the more commonly used name is Hodgkin's disease b) Describe it as a bone tumor c) Call it a tumor of muscle tissue d) Explain that it develops in nerves outside the brain and spinal cord

C

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

C

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: a) behavioral addiction. b) leg ulcers. c) seizures. d) priapism.

C

The nurse is caring for a 17-year-old girl in the terminal phase of osteosarcoma. Which action demonstrates integration of the recommendations of the American Academy of Pediatrics (AAP) Committee on Bioethics? a) Explaining the prognosis using accepted clinical terminology b) Allowing the child to listen during discussions of the care plan c) Telling the child exactly what to expect of further treatments d) Encouraging the child to support the wishes of her parents

C

The nurse is caring for a child with aplastic anemia. The nurse is reviewing the child's blood work and notes the granulocyte count is about 500, platelet count is over 20,000, and the reticulocyte count is over 1%. The parents ask if these values have any significance. Which response by the nurse is appropriate? a) "I'm really not allowed to discuss these findings with you." b) "These labs are just common labs for children with this disease." c) "These values will help us monitor the disease." d) "The doctor will discuss these findings with you when he comes to the hospital."

C

The nurse is caring for a child with leukemia. Which nursing intervention would be the highest priority for this child? a) Encouraging the child to share feelings b) Providing age appropriate activities c) Following guidelines for protective isolation d) Grouping nursing care

C

The nurse is educating the parents of a 16-year-old boy who has just been diagnosed with Hodgkin disease. Which discussion is most appropriate at this time? a) Telling about the drugs and side effects of chemotherapy b) Informing the parents about postoperative care c) Describing the two ways of staging the disease d) Explaining how to care for skin after radiation therapy

C

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? a) "We watch closely for any diarrhea since that usually happens when he takes ferrous sulfate." b) "When I give my son ferrous sulfate I know he also needs potassium supplements." c) "My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C." d) "I always give the ferrous sulfate with meals."

C

The parents of a 6-year-old male 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? a) "ITP is characterized by the loss of surface area on the red blood cell membrane." b) "ITP is a serious bleeding disorder characterized by a decreased, absent, or dysfunctional procoagulant factor." c) "ITP is primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason." d) "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."

C

The nurse is caring for a 10-year-old girl with iron toxicity. What would the nurse expect the physician to order? a) Edentate calcium disodium b) Succimer c) Deferasirox d) Dimercaprol

C Deferasirox is indicated for iron toxicity. It binds with iron, which is removed via the kidneys. Dimercaprol is indicated for blood lead levels greater than 45 mcg/dL. It removes lead from soft tissues and bone, allowing for its excretion via the renal system. Edentate calcium disodium is indicated for blood lead levels greater than 45 mcg/dL. The medication removes lead from soft tissues and bone, allowing for its excretion via the renal system. Succimer is indicated for blood lead levels greater than 45 mcg/dL; it removes lead from soft tissues and bone, allowing for its excretion via the renal system.

The nurse is caring for a 13-year-old girl with von Willebrand disease. After teaching the adolescent and her parents about this disorder and care, which response by the parents indicates a need for additional teaching? A) "We need to administer Stimate prior to dental work." B) "We should be aware that she may suffer from menorrhagia." C) "We should administer desmopressin as often as needed." D) "We understand that she may have frequent nosebleeds."

C) "We should administer desmopressin as often as needed." 24 hours should lapse between doses

A 5-year-old girl is diagnosed with iron-deficiency anemia and is to receive iron supplements. The child has difficulty swallowing tablets, so a liquid formulation is prescribed. After teaching the parents about administering the iron supplement, which statement indicates the need for additional teaching? A) "She needs to eat foods that are high in fiber so she doesn't get constipated." B) "We'll try to get her to drink lots of fluids throughout the day." C) "We will place the liquid in the front of her gums, just below her teeth." D) "We need to measure the liquid carefully so that we give her the correct amount."

C) "We will place the liquid in the front of her gums, just below her teeth."

A nurse is conducting a physical examination of a 5-year-old with suspected iron-deficiency anemia. How would the nurse evaluate for changes in neurologic functioning? A) "Open your mouth so I can look inside your cheeks and lips." B) "Do you have any bruises on your feet or shins?" C) "Will you show me how you walk across the room?" D) "Let me see the palms of your hands and soles of your feet."

C) "Will you show me how you walk across the room?"

The nurse is reviewing the laboratory test results of a child diagnosed with disseminated intravascular coagulation (DIC). Which of the following would the nurse interpret as indicative of this disorder? A) Shortened prothrombin time B) Increased fibrinogen level C) Positive fibrin split products D) Increased platelets

C) Positive fibrin split products *laboratory testing may reveal: - prolonged PT, PTT, aPTT -Decreased level of fibrinogen increase will be noted in levels of fibrinolysis, fibrinopeptide A, positive fibrin split products and D-dimer

The nurse is teaching the parents of a child with a hematologic disorder about the functions of the various blood cells. The nurse determines that the teaching was successful when the parents state which blood cell as being primarily responsible for blood clotting? A) Granulocytes B) Erythrocytes C) Thrombocytes D) Leukocytes

C) Thrombocytes (platelets)

A child with hemophilia fell while riding his bicycle. He was wearing a helmet and did not lose consciousness. He has a mild abrasion on his knee that is not oozing. He is complaining of abdominal pain. What is the priority nursing assessment? a. Perform neurologic checks. b. Assess ability to void frequently. c. Carefully assess his abdomen. d. Examine his knee frequently.

C. The child's complaint of abdominal pain indicates that undetected bleeding may be present in the abdomen. Determining whether internal bleeding is present would take priority over the knee abrasion, which has nearly stopped bleeding.

A 14-year-old with thalassemia asks for your assistance in choosing her afternoon snack. Which choice is the most appropriate? a. peanut butter with rice cake b. small spinach salad c. apple slices with cheddar cheese d. small burger on wheat bun

C. Children with thalassemia should avoid foods that are high in iron. *Spinach, peanut butter, a burger, and whole-grain bread are high in iron. Apples and cheese are not.

A 5-year-old has been diagnosed with Wilms tumor. What is the priority nursing intervention for this child? a. Educate the parents about dialysis, as the kidney will be removed. b. Measure abdominal girth every shift. c. Avoid palpating the child's abdomen. D. Monitor BUN and creatinine every 4 hours

C. Excessive palpation of the abdomen in a child with Wilms tumor can cause seeding of the tumor, leading to metastasis.

A child with cancer is receiving chemotherapy, and his mother is concerned that the nausea and vomiting associated with chemotherapy are reducing his ability to eat and gain weight appropriately. What is the most appropriate nursing action? A. Administer an antiemetic at the first hint of nausea. B. Offer the child's favorite foods to encourage him to eat. C. Start antiemetic drugs prior to the chemotherapy infusion. D. Maintain IV fluid infusion to avoid dehydration.

C. Give the antiemetic prior to the chemotherapy drug to prevent nausea and vomiting

A 3-year-old boy has been brought to the doctor's office with symptoms of anorexia and abdominal pain. A blood test reveals a lead level of 20 μg/100 mL. The child is prescribed an oral chelating agent. On discharge, the nurse should counsel the parents regarding: a) Putting medicine away where children cannot reach it b) Putting child safety locks on kitchen cabinets c) Placing house plants out of reach of children d) Removal or covering of flaking paint on the walls of the home

D

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

D

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

D

A boy with hemophilia A is scheduled for surgery. Which precautions would you institute with him? a) Do not allow a dressing to be applied postoperatively. b) Caution him not to brush his teeth before surgery. c) Mark his chart for him to receive no analgesia. d) Handle him gently when transferring him to a stretcher.

D

A child is to receive radiation therapy this morning. The nurse would expect to see which type of drug prescribed to this child? a) Antineoplastic b) Antipyretic c) Analgesic d) Antiemetic

D

A nurse is counseling parents of a 7-year-old boy with leukemia regarding the goals of the chemotherapy program for their son. What should she mention as the first goal? a) Prevention of leukemia cells from invading or growing in the CNS b) Administration of delayed intensive therapy c) Maintaining the original remission d) Complete absence of leukemia cells

D

A nurse is preparing a teaching plan for a child with hemophilia and his parents. Which information would the nurse be least likely to include to manage a bleeding episode? a) Elevate the injured area such as a leg or arm. b) Apply direct pressure to the area. c) Administer factor VIII replacement. d) Apply heat to the site of bleeding.

D

The father of an 8-year-old boy who is receiving radiation therapy is upset that his son has to go through 6 weeks of treatments. He doesn't understand why it takes so long. In explaining the need for radiation over such a long time, what should the nurse mention? a) Radiation therapy is very weak, and therefore it takes a long time to achieve therapeutic doses b) Insurance companies typically allow only a short radiation treatment per week, to contain costs c) It is difficult to locate where the cancer cells are in the body, so the entire body must be irradiated d) Cells are only susceptible to treatment by radiation during certain phases of the cell cycle

D

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? a) Examination shows temperature of 101.4° F (38.6°C) and headache b) Vital signs show blood pressure measures 120/80 mm Hg c) Observation reveals a cough and labored breathing d) Observation reveals nystagmus and head tilt

D

The nurse is assessing an 11-year-old girl diagnosed with acute myelogenous leukemia (AML) who came to the emergency department. What would alert the nurse to the need for immediate intervention? a) Palpation reveals lymphadenopathy in the axillae. b) Child reports a headache and vision problems. c) Observation discloses weight loss and muscle wasting. d) CBC indicates hyperleukocytosis.

D

The nurse is assessing children in an ambulatory clinic. Which child would be most likely to have iron-deficiency anemia? a) A 3-month-old boy who is totally breastfed b) A 7-month-old boy who has started table food c) An 8-year-old girl who carries her lunch to school d) A 15-year-old girl who has heavy menstrual periods

D

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? a) Encouraging fluid intake to increase radionuclide uptake b) Applying EMLA to the injection site prior to inserting the IV c) Advising the physician that the child is allergic to shellfish d) Administering a sedative as ordered to keep the child still

D

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? a) Sickle cell disease b) Kawasaki disease c) Hemophilia d) Thalassemia

D

The nurse is teaching an inservice program to a group of nurses on the topic of children diagnosed with sickle cell anemia. The nurses in the group make the following statements. Which statement is most accurate regarding sickle cell anemia? a) "The trait or the disease is seen in one generation and skips the next generation." b) "The disease is most often seen in individuals of Asian decent." c) "Males are much more likely to have the disease than females." d) "If the trait is inherited from both parents the child will have the disease."

D

The nurse must calculte the absolute neutophil count for an immune suppressed child. Which is the accurate ANC based on the following laboratory results? Total white blood cell count (WBC): 3000. WBC differential: 10% segmented neutrophils, 8% neutrophil bands. a) 60 b) 240 c) 300 d) 540

D

To prevent further sickle cell crisis, you would advise the parents of a child with sickle cell anemia to: a) administer an iron supplement daily. b) encourage the child to participate in school activities, such as long-distance running. c) prevent the child from drinking an excess amount of fluids per day. d) notify a health care provider if the child develops an upper respiratory infection.

D

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

D

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? a) 6.0 to 9.0 seconds b) 21.0 to 35.0 seconds c) 16.0 to 18.0 seconds d) 11.0 to 13.0 seconds

D 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 recently diagnosed with glucose-6-phosphate dehydrogenase (G6PD) deficiency. The nurse is teaching the parents about triggers that may result in oxidative stress. Which of the following responses indicates a need for further teaching? A) "I doubt he will ever eat fava beans, but they could trigger hemolysis." B) "He must avoid exposure to naphthalene, an agent found in mothballs." C) "He must never take methylene blue for a urinary tract infection." D) "My son can never take penicillin for an infection."

D) "My son can never take penicillin for an infection." *triggers that may result in oxidative stress and hemolysis include bacterial or viral illness * also exposure to certain substances such as medication: sulfonamides, sulfones, malaria-fighting drugs (such as quinine), or methylene blue (for treating urinary tract infections), naphthalene (an agent in mothballs), or fava beans.

The nurse is caring for a 2-year-old boy with hemophilia. His parents are upset by the possibility that he will become infected with hepatitis or HIV from the clotting factor replacement therapy. Which response by the nurse would be most appropriate? A) "Parents commonly fear the worst; however, the factor will help your child lead a normal life." B) "There are risks with any treatment including using blood products, but these are very minor." C) "Although factor replacement is expensive, there's more financial strain from missing work if he has a bleeding episode." D) "Since dry heat treatment of the factor began in 1986, there have been no reports of virus transmission."

D) "Since dry heat treatment of the factor began in 1986, there have been no reports of virus transmission."

The nurse is caring for a child who has been admitted for a sickle cell crisis. Which of the following would the nurse do first to provide adequate pain management? A) Administer a nonsteroidal anti-inflammatory drug as ordered. B) Use guided imagery and therapeutic touch. C) Administer meperidine as ordered. D) Initiate pain assessment with a standardized pain scale.

D) Initiate pain assessment with a standardized pain scale.

The nurse is assessing a 4-year-old girl whose mother reports that she is not eating well, is losing weight, and has started vomiting after eating. Which risk factor from the health history suggests the child may have a Wilms tumor? a) The child has Beckwith-Wiedemann syndrome. b) The child has Schwachman syndrome. c) There is a family history of neurofibromatosis. d) The child has Down syndrome.

A

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: a) petechiae. b) purpura. c) poikilocytosis. d) ecchymosis.

A

The mother of a 5-year-old girl brings the child to the clinic for an evaluation. The mother tells the nurse, "She seems to be so tired and irritable lately. And she looks so pale." Further assessment reveals pale conjunctiva and oral mucous membranes. The nurse suspects iron-deficiency anemia. Which additional finding would help provide additional evidence for this suspicion? A) Spooned nails B) Negative splenomegaly C) Oxygen saturation: 99% D) Bradycardia

A) Spooned nails

The nurse is teaching the parents of a child diagnosed with iron-deficiency anemia about ways to increase their child's intake of iron. The parents demonstrate understanding of the teaching when they identify which foods as good choices for the child? Select all that apply. A) Tuna B) Salmon C) Tofu D) Cow's milk E) Dried fruits

A) Tuna B) Salmon C) Tofu E) Dried fruits

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

C