Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder

The nurse is caring for a toddler taking ferrous sulfate for severe iron-deficiency anemia. Which report by the parent is most concerning? "I brush my child's teeth once every day." "My child's stools are darker than usual." "My child takes ferrous sulfate after meals." "I mix ferrous sulfate with milk in a bottle." SUBMIT ANSWER

"I mix ferrous sulfate with milk in a bottle." Ferrous sulfate may not be absorbed if taken with milk or tea, and if the parent mixes the medicine with milk in a bottle, there is also concern that if the child does not drink the entire amount of medication. Ferrous sulfate may be taken after meals to prevent gastrointestinal irritation. Dark stools are a common side effect of ferrous sulfate. Parents should be encouraged to brush the child's teeth thoroughly to prevent teeth staining.

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

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

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

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

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

An enlarged spleen The child with thalassemia major may have both an enlarged spleen and liver due to excessive iron deposits, fibrotic scarring in the liver, and the spleen's increased attempts to destroy defective RBCs.

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

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

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

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

An experienced nurse is orienting a new nurse to the oncology unit. Which action by the new nurse would require intervention? pouring unused chemotherapy medicine into a sink drain wearing gloves when administering chemotherapy providing information about nausea, mucositis, and susceptibility to infection washing hands well after administering chemotherapy

pouring unused chemotherapy medicine into a sink drain The experienced nurse will need to intervene if the new nurse pours chemotherapy into a sink drain. Chemotherapy drugs should be considered hazardous substances and have special handling procedures (hospital specific protocols should be followed). When administering such agents, nurses should wear gloves and wash the hands well afterward to prevent skin exposure and absorption of the drug. It is appropriate for the nurse to teach the family about possible side effects and how to deal with them.

A nurse is caring for a child diagnosed with medulloblastoma. Which would the nurse expect to include as part of the child's plan of treatment? Select all that apply. radiation therapy use of biologic response modifiers complete surgical resection chemotherapy in high-risk cases Use of preoperative anticonvulsant therapy

radiation therapy chemotherapy in high-risk cases Use of preoperative anticonvulsant therapy Interventions appropriate for medulloblastoma include complete surgical resection, CT or MRI at 72 hours postoperatively, radiation therapy routinely to the entire brain and spine, and chemotherapy in high-risk cases. Biologic response modifiers and preoperative anticonvulsants are not typically included as part of the treatment for medulloblastoma.

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

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

The health care provider has just informed the parents of a 3-year-old that their child has leukemia. The mother begins crying and tells the nurse she does not want her baby to die. What is the nurse's best response? "You are very lucky to have caught it so early; that makes the treatments easier." "I know this is scary, but leukemia has a high cure rate in children these days." "I don't blame you for being upset; any parent would be scared too." "Don't worry, the health care provider is very good at treating leukemia."

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

A mother asks the nurse why her infant who was born at 34 weeks' gestation is being prescribed ferrous sulfate. Which response by the nurse is most appropriate? "Preterm infants are at risk for iron-deficiency anemia." "Ferrous sulfate helps improve red blood cell formation." "Your infant may have been having excessive diarrhea." "Infants with pyloric stenosis require ferrous sulfate."

"Preterm infants are at risk for iron-deficiency anemia." Infants born prematurely are at risk for iron-deficiency anemia because iron stores are built during the last few weeks of gestation. Although some infants with pyloric stenosis may require an iron supplement, such as ferrous sulfate, not all infants will. Infants with excessive diarrhea may develop iron-deficiency anemia, and ferrous sulfate helps improve red blood cell formation, but this does not explain why a preterm infant is being prescribed an iron supplement.

The nurse is caring for a 2-year-old with sickle cell anemia and instructing the parents on the manifestations of the disease. Which statement by the mother indicates a need for further teaching? "Bone infarction, dactylitis, and recurrent pain episodes are acute manifestations." "Delayed growth and development and delayed puberty are chronic manifestations." "The acute manifestations, like splenic sequestration, are most often life-threatening." "Aplastic crisis is a life-threatening acute manifestation of sickle cell anemia."

"The acute manifestations, like splenic sequestration, are most often life-threatening." Splenic sequestration is a life-threatening acute manifestation of sickle cell anemia, but some of the chronic manifestations of the disease, such as pulmonary hypertension and restrictive lung disease, are also often life-threatening. Aplastic crisis is a life-threatening acute manifestation. Bone infarction, dactylitis, and recurrent pain episodes are acute manifestations; delayed growth and development and chronic puberty are chronic manifestations.

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

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

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

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

A nurse is assisting with a bone marrow aspiration and biopsy for a 6-year-old child. Which would be most important? Positioning the child on the side. Asking the parents to leave the room for the procedure. Using aseptic technique for the procedure. Placing a folded blanket or pillow under the head to raise it.

Asking the parents to leave the room for the procedure. Using aseptic technique for the procedure. Children with pernicious anemia have a vitamin B12 deficiency and have symptoms such as pallor, irritability, beefy red tongue, and diarrhea. Children with iron-deficiency anemia require ferrous sulfate. Folic acid is needed for children with macrocytic anemia. Hydroxyurea could be prescribed for a child with sickle cell anemia.

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? Kidney Brain Bladder Blood

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

The child is prescribed liquid ferrous sulfate. The nurse should encourage the child to take which action immediately after each dose to best eliminate possible side effects? Drink a glass of milk Not eat or drink for one hour Remain in an upright position for at least 15 minutes Brush his or her teeth

Brush his or her teeth To prevent staining of the teeth, the child should brush the teeth after administration of iron preparations such as ferrous sulfate. There is no need to remain upright, drink milk or to refrain from eating or drinking for one hour.

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

Call it a tumor of muscle tissue A rhabdomyosarcoma is a tumor of striated muscle that most commonly develops in the head, neck, arms, and legs, as well as in the genitourinary tract, of children.

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

Chemotherapy affects cancer cells and normal cells that multiply rapidly. Chemotherapy is cytotoxic to rapidly proliferating cells—malignant or normal. Normal cells that turn over rapidly include those of bone marrow, hair, and mucous membranes.

An adolescent receiving chemotherapy has lost all hair and is sad about self-image. Which action should the nurse take to support this adolescent and involve the client in decision making? Have a Child Life specialist work with the adolescent. Encourage the adolescent to select hats or wigs to fit one's personality. Support the adolescent's choice of comfortable clothing. Refer the adolescent to a peer support group.

Encourage the adolescent to select hats or wigs to fit one's personality. A positive body image is important, especially to an adolescent. It is important for the nurse to acknowledge the adolescent's feelings of sadness over the body changes caused by the illness. To help the adolescent have some power over the illness, the nurse should encourage the adolescent to choose wigs, hats, or scarves that fit his or her personality or even meet a goal of doing something the adolescent would not have dared to before. This could be a wig of different hair color or a big floppy hat with sequins. Whatever the choice, this gives the adolescent a feeling of being in control of the situation and able to make the decisions. Nurses should support the adolescent's choice of clothing. Most likely the adolescent will choose clothing for comfort. Loose clothing disguises weight loss or scarring while promoting self-esteem. Referring the adolescent to a support group or the help of a Child Life specialist are good interventions. Both will help the adolescent work through the feelings of loss, but neither gives the adolescent the ability to make decisions about outward appearance.

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

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

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? Factor X Factor XIII Factor VIII Factor V

Factor VIII The most common types of hemophilia are factor VIII deficiency and factor IX deficiency, which are inherited as sex-linked recessive traits, with transmission to male offspring by carrier females.

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? Potassium supplements Factor VIII preparations Vitamin supplements Iron-chelating drugs

Iron-chelating drugs Frequent transfusions can lead to complications and additional concerns for the child, including the possibility of iron overload. For these children, iron-chelating drugs such as deferoxamine mesylate may be given. Vitamin and potassium supplements would not be given to treat the iron overload. Factor VIII preparations are given to the child with hemophilia.

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

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

A nurse is providing care to a toddler with nephroblastoma and is being evaluated. Which nursing action would be most important? Preparing the child for chemotherapy Ensuring that the child be allowed nothing by mouth Placing a "no abdominal palpation" sign above the child's bed Restricting the child's visitors Preventing weight-bearing activities

Placing a "no abdominal palpation" sign above the child's bed Nephroblastoma (Wilms tumor) metastasizes rapidly, so it is important that the child's abdomen not be palpated any more than necessary for diagnosis, because handling appears to aid metastasis. There is no need to restrict the child's visitors. Ensuring nothing by mouth would be appropriate prior to surgery. Preventing weight-bearing activities would be appropriate for a child with Ewing sarcoma.

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

Protect the abdomen from manipulation. Manipulation can release malignant cells into the abdominal cavity. Constipation may be a problem following surgical intervention. Pain is uncommon; obtaining a urine specimen is not a priority.

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

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

The nurse is assessing a school-aged child with sickle-cell anemia. Which assessment finding is consistent with this child's diagnosis? Depigmented areas on the abdomen Increased growth of long bones Slightly yellow sclera Enlarged mandibular growth

Slightly yellow sclera In sickle-cell anemia, eye scleras become icteric or yellowed from the release of bilirubin from the destruction of the sickled cells. Mandibular and long bone growth and depigmentation are not manifestations of this health problem.

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

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

A child is to receive radiation therapy this morning. The nurse would expect to see which type of drug prescribed to this child? analgesic antiemetic antipyretic antineoplastic

antiemetic Radiation therapy causes nausea because it destroys rapid-growing cells. Among these are the cells of the stomach lining, the reason that nausea occurs.

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

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

The nurse is 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)? hemoglobin (Hgb) of 11.2 g/dl (112 g/L) platelet count of 250,000 decreased white blood cells (WBCs) macrocytic red blood cells (RBCs)

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

While assessing an adolescent, the nurse notes pallor and a beefy red tongue. Upon questioning, the adolescent reports eating a vegetarian diet to help with weight loss. Which health care provider prescription will the nurse anticipate? ferrous sulfate daily hydroxyurea orally folic acid supplement vitamin B12 injections

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

A couple is expecting a child. The fetus undergoes genetic testing and the couple discover the fetus has sickle cell disease. The couple ask the nurse how most commonly happens. Which statement is accurate for the nurse to provide? "Sickle cell disease is passed to a fetus when one of the parents has the gene." "Sickle cell disease occurs from a random genetic mutation." "Sickle cell disease is passed to a fetus when both parents have the gene." "Sickle cell disease can be passed to the fetus in many ways. We will know more at birth."

"Sickle cell disease is passed to a fetus when both parents have the gene." Sickle cell disease is an inherited disease. The recessive gene is passed from both parents who either have the disease or the trait. There is no need for further testing to determine the cause. There are no other ways to pass the disease other than through genetics. Informing the parents that the gene was passed from both parents is most informative. Sickle cell anemia is not a dominant disease, which is passed when only one parent has the gene, nor is caused by a random mutation.

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

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

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

notify a health care provider if the child develops an upper respiratory infection. Infections caused by the Streptococcus pneumoniae can be lethal to a child with sickle cell, because they can cause overwhelming sepsis or meningitis. By 2 months of age the child should be started on Penicillin V as prophylaxis against pneumococcal infections. The child should receive the 7 valent pneumococcal series in infancy. After 2 years of age the child should receive the 23 valent pneumococcal vaccine. He or she should also be immunized against meningitis. Participating in strenuous activities such as running and limiting the amount of fluids leads to a reduction of oxygen and dehydration. This can lead to the increased sickling of cells. The anemia of sickle cell disease is not the result of iron deficiency. It is the result of the abnormal shape of the red blood cell. Administering iron will not correct the anemia.

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

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

The nurse is explaining the procedure of bone marrow aspiration to a 6-year-old child with leukemia. What explanation would be best to give to the child? "You will need to lie still afterward to prevent a headache." "The numbing medicine on your skin will keep you from having pain." "You may feel pressure on your hip during the procedure." "You will have to lie on your back and hold your breath."

"You may feel pressure on your hip during the procedure." The bone marrow aspiration is performed on the iliac crest if the child is older and on the femur if the child is an infant. Bone marrow aspiration requires hard pressure to allow the needle to puncture the bone. A lidocaine/prilocaine cream is applied to the skin anywhere from 1 to 3 hours prior to the procedure to help numb the site where the needle will be inserted. Bone marrow aspirations and biopsies are usually performed with conscious sedation. If the child is an infant or there are special circumstances the procedure may be performed under anesthesia. The child is placed on the side for the procedure so the health care provider has better access to the iliac crest. The child will need to rest after the procedure to prevent bleeding, but is not required to lay flat on the back. Children who have had a lumbar puncture may need to lie on the back and are at risk for a headache.

A 3-year-old child is hospitalized with a diagnosis of sickle cell anemia and is experiencing a pain crisis. Using the FACES scale, the nurse assesses the child's pain to be a 10 on a scale of 1 to 10. The child is receiving intravenous fluids and oxygen at 2 L/min via nasal cannula. The parent is at the bedside holding the child's hand and has a concerned look. What is the nurse's priority in caring for the child? Implement strategies to address the child's pain. Ask the parent if he or she has questions about the plan of care. Provide diversional activities for the child. Contact the health care provider to meet with the parent.

Implement strategies to address the child's pain. In this case, the nurse's priority is to address the child's pain. The child is already receiving IV fluids and oxygen. That, in combination with analgesia, will assist in resolving the crisis. Asking the parent if he or she has questions, asking the health care provider to meet with the parent, and providing distraction for the child are all appropriate interventions, but the priority is to address the child's pain.

A nurse is preparing a teaching plan for the parents of a child scheduled to have a stem cell transplant. Which would the nurse expect to include in the teaching plan? Select all that apply. Use of general anesthesia for the transplant Monitoring of heart rate and rhythm during the infusion At least 3 to 4 hours for the infusion time Need for strict handwashing to reduce the risk for infection Daily measurements of white blood cell counts

Monitoring of heart rate and rhythm during the infusion Need for strict handwashing to reduce the risk for infection Daily measurements of white blood cell counts With a stem cell transplant, the infusion is administered intravenously into the recipient's bloodstream. Epidural anesthesia or conscious sedation is used if marrow will be obtained directly from a donor, but anesthesia is not needed during the infusion. During the infusion, the child's cardiac rate and rhythm are monitored closely to detect circulatory overload or pulmonary embolism from unfiltered particles. Strict handwashing is key to reducing the child's exposure to bacteria. White blood cell counts are measured daily. The infusion takes approximately 60 to 90 minutes.

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

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

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

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

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

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

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

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

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

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

The nurse is caring for a 14-year-old client scheduled for magnetic resonance imaging (MRI). The nurse explains the test to the child and family. Which information would be most appropriate to include in the explanation? "The MRI is a nuclear scanning test to rule out cancer involving the bones or determine extent of bone involvement." "The MRI uses sound waves to create images that visualize body structures and locate masses." "The MRI uses radiation to examine soft tissue and bony structures of the body." "The MRI uses radio waves and magnets to produce a computerized image of the body."

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

The nurse is caring for a child with hemophilia. The parents are upset by the possibility that the child will become infected with hepatitis from the clotting factor replacement therapy. Which response by the nurse would be appropriate? "There are risks with any treatment including using blood products, but these are very minor." "Parents commonly fear the worst; however, the factor will help your child lead a normal life." "Although factor replacement is expensive, there's more financial strain from missing work if your child has a bleeding episode." "The use of dry heat sterilization has proven to inactivate hepatitis virus, resulting to zero factors transfusion-related incidence of hepatitis infection."

"The use of dry heat sterilization has proven to inactivate hepatitis virus, resulting to zero factors transfusion-related incidence of hepatitis infection." The nurse needs to emphasize that since the inception of heat treatment of the factor in 1986, there have been no reports of virus transmission from factor infusion. Telling the parents that there is a minor risk does not teach. Telling the parents that the factor is expensive or that it is common to worry does not teach, nor does it address their concerns.

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

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

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

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

A toddler diagnosed with beta-thalassemia presents with hyperbilirubinemia, splenomegaly, hepatomegaly, delayed growth and sexual maturation, and abnormal facial appearance. The nurse interprets these findings as reflecting which category of the disease? thalassemia minor thalassemia minima thalassemia major thalassemia intermedia

thalassemia intermedia Thalassemia intermedia becomes apparent during the toddler or preschool years with hematologic abnormalities in conjunction with classic findings of hyperbilirubinemia, splenomegaly, hepatomegaly, delayed growth and sexual maturation, and abnormal facial appearance. Thalassemia minor typically is associated with some abnormal hematologic findings but most are asymptomatic on physical exam. Thalassemia minima causes no clinically important hematologic abnormalities. Thalassemia major is the most severe form of delayed growth and development generally appearing during the first year of life. These children have either no effective production (as in homozygous beta [0] thalassemia) or severely limited production of beta globin.

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

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