Chapter 19 - Hematologic, Immunologic, and Neoplastic Disorders. (PEDS)

The nurse is discharging a child home after a sickle cell crisis. What statement indicates the parents need further teaching? "We will talk to the dentist about any planned dental care visits. " "We will contact the healthcare provider if the child has a fever." "We will report any signs of a respiratory infection immediately to prevent recurrent crises." "If my child has a headache, I will let him rest."

"If my child has a headache, I will let him rest."

The nurse is preparing to transfuse a unit of packed red blood cells to a child. What are the clinical signs and symptoms of anemia that may require the child to receive a blood transfusion? Select all that apply. Tachycardia Inability to perform activities of daily living Cool skin Nose bleed Increased urine output

1, 2

A child is diagnosed with acute lymphocytic leukemia (ALL). The parents are asking the nurse what treatments are available for the child. What are the nurse's responses? Select all that apply. Antibiotics Stem cell transplant Immunotherapy Radiation No treatment

1, 2, 3

What are some critical nursing actions associated with transfusion of fresh frozen plasma for a child with active bleeding? Select all that apply. Don appropriate personal protective equipment. Monitor coagulation studies. Assess for infusion reactions. Infuse the fresh frozen plasma within 6 hours of thawing. Pre-medicate with antihistamines.

1, 2, 3, 4

A nurse is planning care for a patient with thrombocytopenia. Which nursing intervention will be included? Select all that apply. Monitoring stools for blood Avoiding injections Avoiding use of salicylates (aspirin) Avoiding steroids Monitoring activities

1, 2, 3, 5

The nurse is accessing a child's central line for chemotherapy. What are important nursing actions with central line access? Select all that apply. Use only 10mL syringes to flush the line. Maintain aseptic technique. Identify the child with two identifiers. Have the child preform hand hygiene. Wear gloves when working with a child's central line.

1, 2, 3, 5

A nurse is planning care for a child with acute lymphocytic leukemia (ALL). Which statement is true? Select all that apply. Swollen glands are a clinical manifestation of ALL. ALL is the most common type of cancer in children. Philadelphia chromosome abnormality is a possible cause of ALL. Previous chemotherapy is a possible cause of ALL. The cause is unknown.

1, 2, 4

A nurse is providing care to a child with an oncologic disorder. Please identify nursing interventions for the child. Select all that apply. Monitor for seizures and changes in posturing. Assess oral cavity for stomatitis. Place the child in Trendelenburg position to facilitate drainage. Monitor level of consciousness and sleep patterns. Allow the child to lie with head sideways on the pillow.

1, 2, 4

A nurse is assessing for indications to administer packed red blood cells. Select indications for administration. Select all that apply. Impending heart failure Recurrent priapism Hemoglobin >8 grams in a stable patient with chronic anemia Hypervolemia Splenic sequestration

1, 2, 5

A nurse is planning care for a positive human immunodeficiency child (HIV) positive child. Which interventions will the nurse include? Select all that apply. Follow standard precautions when providing care. Administer highly active antiretroviral therapy drugs (HAART) combination therapy. Strictly adhere to a low sodium, low calorie diet. Immunization is not recommended against common childhood illnesses. Prevent and manage opportunistic infections.

1, 2, 5

A nurse is planning prioritized care for children with complex hematologic and oncologic disorders. Which statements are true related to prioritized care? Select all that apply. Triage clients quickly and place in a treatment room as soon as possible. Avoid invasive procedures. Use strict standard precautions. Start antibiotics if febrile within 24 hours of assessment. Dedicate stethoscopes and equipment to the room.

1, 2, 5

A nurse is teaching a caregiver of a child receiving radiation therapy about possible side effects. Which would the nurse identify? Select all that apply Retinopathy Alopecia Bulimia Cardiomegaly Sterility

1, 2, 5

A nurse is teaching the caregiver of a child with lead poisoning. Caregiver education will include which of the following? Select all that apply. Instructing about lead hazards and sources Relocating the child from the environment until lead is removed Cleaning the environment with a disinfectant and discard in a puncture resistant container Referring to a physical therapist to evaluate the child as needed Referring to a speech and child developmental specialist to evaluate child as needed

1, 2, 5

A nurse is assessing a child with a hematologic disorder. Children with a hematologic disorder may present with: (Select all that apply) Edema Bradycardia Delayed learning Brittle and concave nails Increased serum concentration of the proteins albumin, gamma globulin, and transferrin

1, 3, 4

A nurse is planning care for a child with suspected lead poisoning. Which diagnostic tests are utilized? Select all that apply. Free erythrocyte protoporphyrin (FEP) Liver function test Urinalysis Bone radiography Blood glucose

1, 3, 4

A nurse is teaching a caregiver of a child with aplastic anemia. Which statement should the nurse include in the teaching? Select all that apply. There is a history of illness that does not heal. Monitor for hyperactivity. Monitor immunosuppressive therapy to remove functions that prolong aplasia. There is an increased percentage of reticulocytes. Prevent infection with strict adherence to droplet precautions.

1, 3, 4

A nurse is assessing a child with acquired thrombocytopenia. Which findings would the nurse identify as consistent with this diagnosis? Select all that apply. Recent exposure to Rocky Mountain spotted fever Painful urination Petechiae over bony prominences Exposure to radiation Exposure to chemicals

1, 3, 5

A nurse is assessing clinical indications for administration of platelets. Select indications for administration. Select all that apply. Platelet count <20,000 Hypervolemia Thrombocytopenia Pallor Active bleeding

1, 3, 5

A nurse is teaching a child and caregiver prior to diagnostic testing for a childhood cancer. Which statement is true relating to diagnostic testing? Select all that apply. State what the child will experience. Encourage the child to be a big boy/girl. Avoid distraction techniques. Consider the developmental level of the child. Give the child equipment or pictures of equipment to play with prior to the procedure.

1, 4, 5

The nurse is teaching a caregiver of a child with human immunodeficiency virus (HIV). Which statement regarding caring for a child with HIV are true? Select all that apply. Educate day-care and school staff on current HIV information. Encourage the use of pharmacologic pain interventions. Dependence on opioids may require decreased dosing over time. Emphasize time of administration of highly active antiviral therapy (HAART) Foster positive self-concept.

1, 4, 5

A nurse is planning to administer a blood transfusion to a child with sickle cell disorder. Please identify the steps in order for administration. Obtaining the informed consent Reviewing the results of blood count and plan of care Educating the child/family Obtaining vital signs

2, 3, 1, 4

A nurse is planning care for a child with hemophilia. Which statement is true in the care of the child with hemophilia? Select all that apply. Hemophilia is commonly a deficiency of factor X. Hemarthrosis into the joint cavities of a child with hemophilia is a clinical manifestation. Hemophilia A and B are inherited as X-linked recessive traits. Spontaneous hematuria in children with hemophilia is a clinical manifestation. Males are carriers and do not have the disease.

2, 3, 4

A nurse is planning care for a child with sickle cell disease. Which interventions are utilized in the care of the child? Select all that apply. Metabolic alkalosis treatment with IV replacement Administration of Hydroxyurea Positive self-talk Activity and rest cycling for periods of activity intolerance Liver resection as a life saving measure

2, 3, 4

A nurse is teaching a caregiver of a child with Wilms' tumor. Which statement regarding care of the child is true? Select all that apply. Side effects of cancer treatment are usually not evident after six months. Do not palpate the tumor. Avoid pushing or lifting in tumor area. Genetic counseling may be ordered. Chemotherapy and radiation typically eradicate the tumor

2, 3, 4

A parent asks the nurse what could have caused his child to have cancer. What are possible causes of cancers? Select all that apply. Surgeries Chemical carcinogens Radiation Viruses Infections

2, 3, 4

A nurse is assessing a child with a brain tumor. Identify assessment findings associated with this diagnosis. Select all that apply. Decrease in head size Sluggish pupils Unequal and weak hand grasp Headache at bedtime Nausea and vomiting

2, 3, 5

A nurse is teaching a caregiver of a child with cancer. Which statement regarding caregiver education is true? Select all that apply. Discourage discussions centered around caregiver guilt. Provide education to the caregiver and child. Explain the plan of care for the child. Avoid discussions on survival rate. Encourage emotional support.

2, 3, 5

A nurse is teaching a caregiver of a child with iron deficiency anemia. Caregiver education relating to iron deficiency anemia includes: Avoid consumption of cow's milk in infants until age 10 months. For breastfed infants, provide an iron supplement. Teach parents to add iron-rich foods to child's diet. Iron supplementation is required if the child is bottle fed. Whole milk is recommended from 12 months to two years.

2, 3, 5

A nurse is assessing a child with Acquired Immunodeficiency Syndrome (AIDS). Which assessment findings are present? Select all that apply. Chronic or recurrent urinary tract infection Mucocutaneous eruptions Epiglottitis Parotitis Chronic or recurrent diarrhea

2, 4, 5

A nurse is teaching a caregiver about autologous blood transfusion. Which statements are true? Select all that apply. Confirm parents' willingness for transfusion. Confirm patient's self-donation with parents. Observe urinary output. Observe vital signs as with other blood products. Verify client identification.

2, 4, 5

A nurse is planning care for a human immunodeficiency virus (HIV) positive child. Which interventions will the nurse include? Select all that apply. HIV enzyme-linked immunosorbent assay (ELISA) is recommended for children six months and older. Virologic diagnostic testing is recommended for infants six months and older. In children 18 months or older, use HIV antibody assays. Western blot immunoassay is used for children 18 months and older. Rapid HIV testing may include oral specimen collection.

3, 4, 5

A nurse is planning to administer chemotherapy to a child. Please prioritize nursing interventions for administration. Provide child safety by using two forms of patient identifiers. Anticipate need for anti-emetic medication and hydration. Identify adverse effects of medication promptly. Assess child and caregiver understanding of the disease and treatment.

4, 2, 1, 3

A nursing priority is the high-risk of infection for the child with an oncologic disorder. The child's laboratory findings reveal (3% Bands , 50% Segs) Total WBC count=1000 Calculate the child's Absolute Neutrophil Count (ANC) based on the provided information.

530

A nurse is planning nursing interventions to promote nutrition and hydration in a child diagnosed with cancer. Which interventions should the nurse include? Offer any tolerated food and drink every four hours if needed. Allow the child to be involved in food and drink selection. Avoid allowing the parents to bring food from home. Assess the child for bulimia.

Allow the child to be involved in food and drink selection.

A nurse is assessing a child with suspected lead poisoning. Which should the nurse expect to assess in this patient? Screening should occur no later than six months. Selective screening should occur ages seven and eight. Assess for urinary symptoms. Assess for central nervous symptoms.

Assess for central nervous symptoms.

A nurse is planning care for a child with non-Hodgkin's lymphoma. Which statement is true for the child? Enlargement of lymph nodes Reed-Sternberg cells are present Noticeable enlarged cervical or supraclavicular nodes Stages I-IV using the Cotswold Modified Ann Arbor system

Enlargement of lymph nodes

A nurse is planning administration of fresh frozen plasma (FFP). Which statement is true? It is a replacement for deficiency of hemoglobin and hematocrit. FFP product must be used within eight hours of thawing Fibrinogen levels must be below 150 mg/dL. Warfarin anticoagulant administration indicates FFP.

FFP product must be used within eight hours of thawing

A nurse is teaching a caregiver of a child regarding oncology emergencies. Which would the nurse consider? Hypervolemia Hyperleukocytosis Hyperglycemia Hypernatremia

Hyperleukocytosis

A child is diagnosed with iron deficiency anemia. What will the nurse see as common clinical presentation findings? Irritability, tachycardia, brittle and concave nails Increased serum concentration of the proteins albumin, gamma globulin, and transferrin Anorexia, bradycardia, and systolic murmur Normal growth, spastic muscle tone, and delayed learning

Irritability, tachycardia, brittle and concave nails

A child with a vegan diet is diagnosed with iron-deficiency anemia. What iron-rich foods will the nurse suggest the parents add to child's diet? Dark leafy vegetables, fish, lean beef Poultry, fortified cereals, fish Organ meat, shellfish, legumes Legumes, fortified cereals, molasses

Legumes, fortified cereals, molasses

A nurse is planning nursing interventions for a child with Wilms' tumor. Which intervention should be included? Monitor manual blood pressures. Plan chemotherapy after surgery. Palpate the abdomen to assess for mass. Wear fitted material for comfort.

Monitor manual blood pressures.

A nurse is teaching about various cancers in children. Which type of cancer is usually diagnosed <1 year of age? Wilms' tumor Neuroblastoma Eye cancer Hodgkin's cancer

Neuroblastoma

A nurse is teaching a caregiver of a child with leukemia. Which statement is true relating to care of the child? Neutropenia with infection of skin and lungs is present. Prepare child for radiation and decrease activity intolerance Represents 50% of childhood cancers Headache on awakening

Neutropenia with infection of skin and lungs is present.

The nurse is teaching a caregiver about foods to include in an iron-rich diet. Which food should be included? Lean beef Organ meats Dark green leafy vegetables Potatoes

Organ meats

A nurse is monitoring a child with suspected thrombocytopenia. The nurse will observe for which clinical manifestations: History of epistaxis Petechiae, often over bony prominences History of sickle cell Recent exposure to bacterial pneumonia

Petechiae, often over bony prominences

A 12-year-old male child is diagnosed with acquired thrombocytopenia (ATP) after an infection with Rocky Mountain spotted fever. The nurse understands that which diagnostic exam will identify ATP? Partial thromboplastin time: 28 seconds Total iron-binding capacity values: 280 mg/dL Platelet count: 80 x 103/mcL Hemoglobin: 13.5 g/dL

Platelet count: 80 x 103/mcL

A nurse is teaching a caregiver for the child undergoing hematopoietic stem cell transplantation (HSCT). Which statement is true for the child? Discourage sibling participation in child's care until stabilized. Care will be provided only by trained personnel. Prepare the child for isolation to undergo intensive ablative therapy. Adherence to standard precautions is warranted.

Prepare the child for isolation to undergo intensive ablative therapy.

A nurse is assessing a child for leukemia. Which assessment finding confirms diagnosis? Purpura Auditory hallucinations Bulimia Bone and joint infection

Purpura

A patient is diagnosed with a terminal brain tumor. What teaching should the nurse include with the recommended palliative treatments? The chemotherapy will shrink the brain tumor. The child will not have pain as therapy continues. Radiotherapy will shrink the brain tumor. There are no side effects with radiation therapy.

Radiotherapy will shrink the brain tumor.

A nurse is planning care for a child with suspected sickle cell disease. Which diagnostic test will yield results within minutes to determine if Hgb S present? Hematocrit Sickle cell turbidity test Hemoglobin electrophoresis Liver function test

Sickle cell turbidity test

A nurse is assessing for clinical signs and symptoms of anemia. Which assessment findings are present? Hypertension Syncope Bradycardia Ruddiness

Syncope

A nurse is planning care for a child with a suspected oncologic disorder. Which statement is true relating to oncologic disorders with children? Possible cancer causes are heredity and genetics. Causes of most cancers are known. Hodgkin's lymphoma is typically untreatable. Wilms' tumor of the kidney is typically discovered by caregivers.

Wilms' tumor of the kidney is typically discovered by caregivers.

A nurse is preparing medications for administration. Nursing interventions for iron administration include: SQ injection method for iron dextran (Imferon) Iron supplementation may be necessary in some populations Z-track injection method for iron dextran (Imferon) Liquid dosage of iron administered with a medication cup

Z-track injection method for iron dextran (Imferon)