EAQ

The nurse administers morphine to a child in hospice care, but the child does not verbalize relief from pain. The primary health care provider instructs the nurse to increase the drug dosage. The parents express their concern about addiction. Which statement made by the nurse regarding the pain medication is appropriate in this situation?

"Don't worry. Increasing the dosage of morphine will not cause addiction."

The registered nurse is teaching a student nurse about how parents should tell a child that he or she is terminally ill. Which statement made by the student nurse requires correction?

"Encourage the parents not to speak openly about death."

A mother says to a nurse that the sibling of her chronically ill child always fights with the child. The mother says she is working with the sibling on coping mechanisms to help the sibling accept the reality of the situation. Which behavior of the mother needs correction?

"I have explained that the chronically ill child is my focus when we are in the hospital."

A mother of a chronically ill child tells the nurse that her other child is angry with the sick child. Which statement made by the mother would describe the reason for the child's anger?

"I make the sibling sleep in a different room."

A nurse is teaching the parent of a chronically ill child how to help siblings cope with the illness. Which statement made by the parent indicates a correct understanding of the information presented? .

"I should invite the siblings to join meetings to develop a care plan for the ill child." "I should discuss plans with the siblings." "I should praise siblings for their patience."

A registered nurse is discussing with a student nurse the ways to communicate with the parents of a chronically ill child. Which statement made by the student nurse needs correction?

"I should refrain from saying 'I don't know'."

Which statement would an adolescent give when a nurse asks about his or her perception of death?

"I will not die at a young age."

A mother wishes to see her deceased infant after the infant is taken to the hospital morgue. What would be the best nursing intervention in this situation?

Bring the infant to the mother's room.

A nurse is teaching the family of a chronically ill child about the child's potential reactions toward the illness. Which statements should be included in the teaching?

"The child could be easily irritated." "The child will become dependent on others." "The child's fine motor development is affected."

A child with β-thalassemia is receiving numerous blood transfusions. In addition, the child is receiving deferoxamine therapy. The child's parents ask the nurse what deferoxamine does. What is the most appropriate response by the nurse?

"The medication helps prevent iron overload."

Which statement made by the student nurse indicates a correct understanding of the family-centered care concept?

"The nurse and parents should mutually develop strategies of care."

A nurse is teaching the parents of a child with a chronic illness about a sibling's potential reactions toward the illness. Which statement made by the parents indicates effective learning?

"The sibling experiences the loss of a playmate." "The sibling may harbor feelings of loneliness and jealousy." "The sibling may be fearful of contracting the same condition."

The parents of a child with sickle cell anemia are concerned about subsequent children having the disease. Which response by the nurse is most accurate?

"There is a 25% chance of a sibling having sickle cell anemia."

A mother of a terminally ill child tells the nurse, "Sometimes I wonder if I am doing the right thing." What is the most therapeutic response?

"What are your concerns right now?"

The student nurse is teaching the parents of a child who is receiving palliative care how to explain death to the child in a developmentally appropriate manner. Which statement made by the student nurse needs correction?

"You should use phrases such as 'pass away' instead of 'die'."

What advice should the nurse give to the family of a child who has microcytic hypochromic anemia?

Brush the child's teeth after giving oral iron supplements.

A nurse is talking with the parent of a child with a newly diagnosed chronic illness. What is the most appropriate way for the nurse to assess how the parent is coping with the diagnosis?

By asking an open-ended question

Which procedure does the nurse identify as the means of eliminating excess iron in a child with thalassemia major?

Chelation therapy

What are the goals associated with hospice care?

Live life with choices and dignity Live life to the fullest without pain Live life with the support of family Live life in the familiar environment of home

A 3-year-old child is scheduled for surgery to remove a Wilms tumor from one kidney. The parents ask the nurse what treatments, if any, will be necessary after recovery from surgery. The nurse's explanation should be based on what knowledge?

Chemotherapy with or without radiotherapy is indicated

The nurse is caring for a child with a terminal illness who is approaching death. What physical signs can the nurse expect the child to demonstrate?

Cheyne-Stokes respiration

A child who is dying of cancer exhibits a weak, slowed pulse. What does this finding indicate to the nurse?

Approaching death

The nurse is caring for an 8-year-old child who has been hospitalized with a chronic illness. The child has a tracheostomy and a parent is rooming-in. The parent insists on providing almost all of the child's care and tells the nurses how to care for the child. When planning the child's care, the primary nurse should recognize that the parent is exhibiting which behavior?

Assuming the role of expert in care of the child

Which factors will influence self-care in the chronically ill hospitalized child?

Child's developmental age Child's level of interest Child's physical ability

The parents of a terminally ill child tell the home nurse that they do not believe in God and hence do not see the point of praying for their child's recovery as suggested by a hospice worker. The nurse is a religious person who engages in religious activities. How does the nurse appropriately respond to this situation?

Assures the family they can seek comfort without prayer

What test is essential for the definitive diagnosis of leukemia?

Bone marrow aspiration

A young girl complains of pain in her right leg that is relieved when she places the leg in a flexed position. The girl's mother reports that her daughter frequently limps and is unable to hold heavy objects for even a short amount of time. On assessment the nurse notes a small palpable mass on the girl's right lower leg. What do these clinical manifestations suggest?

Bone tumor

What is true for both sickle cell disease and hemophilia?

Both are genetically transmitted diseases.

A nurse is caring for a child with asthma. Which strategy should the parents follow?

Listen to the chronically ill child.

A chronically ill infant has died. Which is the best nursing intervention?

Accept the family's grief reactions.

What serious complication of sickle cell disease is similar to pneumonia?

Acute chest syndrome

The nurse is caring for a child in hospice. While listening to the child's breathing, the nurse observes "death rattle." What action does the nurse perform in reducing these noisy chest sounds?

Administer anticholinergic medication.

Transdermal fentanyl is being used for an adolescent with cancer who is in hospice care. The adolescent has been comfortable for several hours but now complains of severe pain. What is the most appropriate nursing action?

Administering morphine sulfate immediate release (MSIR) intravenously

What are the most common signs and symptoms of leukemia related to bone marrow involvement?

Anemia, infection, bleeding

What is a common experience of a sibling during a sister's or brother's illness or hospitalization?

Anger

A three-year-old child develops oral ulcers as a side effect from chemotherapy. What nursing interventions should be done to take proper care of the child's mouth?

Clean the mouth with a soft sponge toothbrush. Rinse the mouth with chlorhexidine mouthwash. Keep child on a bland, moist, soft diet.

A child with non-Hodgkin's lymphoma is undergoing chemotherapy with cyclophosphamide. What are the appropriate nursing actions to prevent sterile hemorrhagic cystitis in this child?

Close monitoring for presence of hematuria Administration of mesna to inhibit urotoxicity Frequent voiding immediately after the urge is felt

A 2-month-old formula-fed baby is brought in for a routine checkup. The parent of the baby tells the nurse that a friend has advised her to give fresh cow's milk to the baby instead of formula milk because it has high nutritional value. What is the nurse's best response?

Cow's milk should be avoided before 12 months of age, because it may cause iron-deficiency anemia.

What does the nurse recognize as the best description of a preschooler's concept of death?

Death is a departure, a kind of sleep.

What is a 4-year-old child's concept of death?

Death is temporary.

Denial is a common reaction to the diagnosis of a disability or chronic illness. Which statement applies to denial as a defense mechanism?

Denial is a necessary cushion to prevent disintegration of the family's psyche.

The nurse is counseling the family of a dying child to cope with the situation. Which action of the nurse needs correction?

Discouraging the parents from sharing their sorrow with the child

The nurse is assessing the findings of a microscopic study of red blood cell (RBC) morphology. Which assessment finding does the nurse recognize as a sign of sickle cell anemia (SCA)?

Drepanocytes

The school nurse is caring for a boy with hemophilia who fell on his arm during recess. What supportive measures should the nurse use until factor replacement therapy can be instituted?

Elevating the area above the level of the heart

What are the most common clinical manifestations of hemophilia?

Excessive bruising Hemorrhage from any trauma Prolonged bleeding from or in the body

A nurse is caring for a 4-year-old chronically ill child and notices that the parent allows the child to have his or her own way in spite of the nurse encouraging the child to participate in his or her care. Which guidance given by the nurse to promote normalizing in this relationship is most appropriate?

Explain that the child is likely to develop independence with less interference.

A 9-year-old child who is being treated for chronic obstructive pulmonary disease (COPD) asks the nurse why he or she is receiving fluticasone propionate. How should the nurse respond?

Explain the reason in simple words

What are the clinical manifestations of Wilms tumor?

Fever Fatigue Hematuria Abdominal swelling or mass

What are the most common clinical features of sickle cell anemia in children?

Gallstones Hematuria Osteomyelitis Hepatomegaly

The parents of a child who is on a long-term steroid therapy are worried about the child's appearance. The child has gained a lot of weight and has excessive hair growth. The nurse finds that the child has moon face, pendulous abdomen, and red abdominal striae. What does the nurse tell the parents of the child?

Give the drug on alternate days. Give the drug early in the morning.

A 4-year-old child is prescribed liquid iron for iron-deficiency anemia. What instructions are given to the parents of this child?

Give the iron using a straw. Brush the child's teeth after administration of iron.

A child with sickle cell disease is brought to the hospital reporting right knee pain. On examination, the nurse finds localized swelling and immediately applies a cold compress to the right knee, massages the knee, and administers ibuprofen for pain relief. The nurse informs the mother that the child may need a high dose of an opioid if there is no relief from pain. Which of the measures taken by the nurse need to be corrected?

Giving cold compression to the affected area

What is a common side effect of several chemotherapeutic drugs?

Hair loss

The nurse is explaining blood components to an 8-year-old child. The nurse, drawing on knowledge of child development, understands that the most appropriate description of platelets is that they do what?

Help the body stop bleeding by forming a clot (scab) over the hurt area

What should the nurse teach the family about caring for a child with sickle cell anemia?

Identify early signs of dehydration. Administer prophylactic penicillin. Encourage the child to drink a lot of fluids. Check the child for proper hand-washing technique.

The parents of a child with seizure disorder tell the nurse that the child's illness has changed their routine and is creating stress. What are the most important nursing actions in this case?

Identify effective coping strategies. Normalize the life of the child. Identify appropriate support systems.

What effects can result from chronic illness or disability in toddlerhood?

Increased dependence on parent

The parent of a 2-year-old child tells the nurse, "My child mostly drinks milk and fruit juice and consumes very little solid food." The nurse further assesses the child for which condition?

Iron deficiency

How is proton beam radiation different from traditional form of radiation?

It emits positively charged subatomic particles.

The parents of a terminally ill child are very anxious as they ask the home care nurse about the child's progress. The nurse knows that any improvement in the child's condition can be determined only after three weeks. What does the nurse inform the parents?

It may take a couple of weeks to determine progress."

A health care provider orders a positron emission tomography (PET) scan on a patient following the removal of a tumor in the skull. The patient asks the nurse about the importance of this scan. What does the nurse tell the patient?

It measures the blood flow to the brain. It detects biochemical changes in tissue. It detects the metabolic activity in the brain.

A child who is terminally ill with bone cancer is in severe pain. Nursing interventions should be based on which knowledge?

Large doses of opioids are justified when there are no other treatment options.

The nurse is caring for a child with osteosarcoma who recently underwent amputation of the lower right leg. The child is complaining of severe pain and itching in his right foot. What is the best response by the nurse

Letting the child know that the sensations are real, not imagined

The family of a dying child expresses concern to the nurse that their child is sleeping more and doesn't want to eat. What does the nurse explain occurs physically as death is approaching?

Loss of bowel and bladder control Increased sleep and decreased appetite Mottling of the skin and muscle weakness

How is childhood non-Hodgkin's lymphoma (NHL) different from Hodgkin's lymphoma?

NHL disseminates earlier, more often and more rapidly.

The nurse stresses to the family of a child with a chronic cardiac condition the importance of enrolling the child in school, pursuing hobbies and recreational interests, and attaining some independence. The nurse is facilitating what concept?

Normalization

The nurse is caring for a toddler who has undergone surgery for a brain tumor. During an assessment the nurse notes that the child is becoming irritable and the pupils are unequal and sluggish. What is the most appropriate nursing action?

Notifying the care practitioner immediately

The nurse is taking the medical history of a child suffering from anemia. What areas should the nurse emphasize? .

Nutrition Eating habits Bowel habits Family history History of chronic infection

The nurse is caring for a child with leukemia. The patient has severe pain associated with weight loss following a chemotherapy treatment. What intervention does the nurse perform for improving the health status of the patient?

Nutritional therapy

A child with a brain tumor has undergone craniotomy. What are the postoperative nursing care measures to undertake once the child is alert?

Observe the dressings for evidence of drainage. Restrain the child from touching his or her head. Check handgrip reflexes and functioning of the cranial nerves.

The nurse is teaching the parents of a preterm infant ways to prevent possible nutritional deficiency anemia. What recommendations should the nurse make?

Provide breast milk as much as possible. Give citrus fruit or juice with iron supplements. Administer iron supplements in two divided doses between meals. Limit quantities of milk and introduce solid food rich in iron, fluoride, zinc, and vitamin C.

What is the priority of nursing care for children in the terminal stages of an illness?

Providing adequate pain control

What is the primary treatment for hemophilia?

Replacement of missing clotting factor

What is the most common congenital malignant intraocular tumor of childhood?

Retinoblastoma

A child suffering from retinoblastoma is admitted to the hospital and scheduled for surgery. The child's parents are very apprehensive about the surgery and the appearance of the child after surgery. Which is the most appropriate action by the nurse?

Show the parents a picture of another postsurgery child who has an artificial eye

Which ethnic groups are tested due to the increased incidence of the genetic disorder in the specific ethnic group?

Tay Sachs disease and Ashkenazi Jews Sickle cell anemia and African-Americans Thalassemia and people of Mediterranean decent

What does the nurse recognize as the most important nursing consideration in the care of a child with sickle cell anemia?

Teaching the parents and child how to recognize signs and symptoms of crisis

An instructor is teaching a group of nursing students about ethical considerations for managing symptoms in terminally ill patients. Which information is appropriate to include in the teaching?

Terminally ill patients need palliative care.

Globins protein mutations result in which disorder(s)?

Thalassemias Sickle cell disease

The nurse observes that the usual dose of analgesic is unable to relieve pain in a 12-year-old child with sickle cell anemia after 3 weeks. What does the nurse conclude from this finding?

The child has developed tolerance to analgesic.

The nurse is caring for a child who was recently diagnosed with cancer. The nurse observes that the child refuses to interact with any staff members. What is the most likely reason for the child's lack of interaction?

The child is in a state of shock and denial.

The transcranial Doppler test results of a child with sickle cell anemia indicate that the child has abnormal intracranial vascular flow. What information does the nurse give to the parents?

The child may require multiple blood transfusions.

The nurse explains to the family of a dying child the principles of palliative care. What are those hallmark principles of palliative care?

The child patient and family are the unit of care An interdisciplinary team of health care professionals are part of the child's care Focus is on relief of suffering but curative treatments will be used if appropriate

A school-aged child is diagnosed with sickle cell disease. The care plan is based on the concepts of family-centered care. Which factors should be considered by the nurse?

The child's opinion about the treatment The effect of the chronic illness on siblings The family's responsibility in the care delivery

A 5-year-old child's sibling dies of sudden infant death syndrome. The parents are concerned because the child showed more outward grief when their cat died than at the sibling's death. The nurse draws on knowledge of development to explain what?

The death may be so painful that the child must deny it for now to protect her psyche.

The nurse is assessing a child with a terminal illness who may need total parenteral nutrition (TPN) at home after discharge. In this situation, what does the nurse discuss with the parents during the assessment?

The nurse clarifies expectations and goals for home care.

Which intervention is most appropriate regarding a child's attendance at a sibling's funeral service?

The parents should explain how the deceased child will look.

What best describes the concept of death of 8-year-old children?

They particularly fear the mutilation and punishment they associate with death.

An infant who is treated with iron supplements has developed constipation. The parents ask the nurse if they can use the low-iron containing formula to help the child. What should the nurse tell them?

They should not switch to low-iron-containing formula or whole milk.

What is the purpose of palliative chemotherapy or palliative radiotherapy?

To enhance the quality of life of the patient To increase comfort by slowing the progression of an incurable tumor To increase comfort by reducing swelling or pressure from a tumor that is causing pain

The nurse reviews the laboratory report of a child with leukemia who is receiving chemotherapy. The nurse notices that the platelet count is severely reduced. Based on the laboratory report, what does the nurse include in the plan of care?

To use a soft brush for dental care

A young mother inquires about the future of her child and the risk for cancer. What is the current knowledge about cancer genetics?

Tumor suppressor genes are found in many cancers. Environmental agents act as triggers, increasing inherited risk factor. BRCA1 is a cancer suppressor gene for female breast and ovarian cancer.

What is the similarity between acute lymphoblastic leukemia (ALL) and acute myelogenous leukemia (AML)?

Unrestricted proliferation of immature white blood cells

Nursing care of the child with myelosuppression from leukemia or chemotherapeutic agents should include which intervention?

Use of good handwashing technique

The nurse is teaching the family of a chronically ill child about strategies to empower themselves. Which strategy will be the most effective?

Using family-to-family support networks

The nurse is conveying some bad news to parents about their child, who is chronically ill. Which action of the nurse needs correction?

Using medical terms to explain in-depth information

The nurse is caring for a 10-year-old child whose white blood cell count is high. The child asks the nurse about the significance of white blood cells. What is the most appropriate response of the nurse?

White blood cells help keep germs from causing infections.

The nurse is teaching a female, adolescent patient with sickle cell anemia about the complications associated with her disease. Which statement should the nurse include while educating the patient?

Women with sickle cell anemia are at risk for pregnancy-related disorders."

The nurse caring for a child who has just died is responsible for preparing the body after death. What can the nurse do to provide family-centered care after the death of a child?

sking the family whether there are any specific methods that they use to help them cope with and mourn death

The parent of a 4-month-old infant asks the primary health care provider about a substitution for breast milk. What recommendation should the primary health care provider make?

ubstituting with iron-fortified formula