FINAL PED CHAPTER 24

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." "I mix ferrous sulfate with milk in a bottle." "My child takes ferrous sulfate after meals."

"I mix ferrous sulfate with milk in a bottle." Explanation: 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? "When I give my son ferrous sulfate I know he also needs potassium supplements." "I always give the ferrous sulfate with meals." "My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C." "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."

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? "Infants with pyloric stenosis require ferrous sulfate." "Preterm infants are at risk for iron-deficiency anemia." "Your infant may have been having excessive diarrhea." "Ferrous sulfate helps improve red blood cell formation."

"Preterm infants are at risk for iron-deficiency anemia."

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

"She has been down, but playing in soccer camp will cheer her up."

The parents of a child diagnosed with cerebral astrocytoma ask the nurse about their child's prognosis. Which response by the nurse would be most appropriate? "The prognosis is favorable with complete surgical resection and the child usually experiences minimal neurologic deficits post-operatively." "There is a poor overall prognosis with a survival rate less than 10% and a median survival time of 2 years." "Survival is variable from several months to ten years or longer. Children who have a complete resection have the best prognosis." "The survival rate is greater than 95% with radiation and complete surgical resection."

"The prognosis is favorable with complete surgical resection and the child usually experiences minimal neurologic deficits post-operatively." Explanation: Cerebral astrocytomas account for approximately 25% of all types of astrocytomas. The prognosis is favorable with complete surgical resection, and patients have minimal neurologic deficits post-operatively. "brain tumor"

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: "We should administer the drug on an empty stomach." "We should check our son's urine for glucose." "He might develop a rounded face from this drug." "We will need to gradually decrease the dosage."

"We should administer the drug on an empty stomach."

The nurse is preparing a presentation for a local parent group about nutritional measures to prevent anemia. The group of parents have children between the ages of 4 and 8. The nurse would recommend a daily iron intake of which amount? 10 mg 6 mg 12 mg 15 mg

10 mg Explanation: The recommended daily dietary iron intake for children 1 to 10 years of age is 10 mg. The recommended daily dietary iron intake for children 0 to 6 months of age is 6 mg. The recommended daily dietary iron intake for boys 11 to 18 years of age is 12 mg. The recommended daily dietary iron intake for girls 11 to 18 years of age is 15 mg.

The nurse is describing the phases of treatment to a child who was diagnosed with leukemia and his parents. How would the nurse describe the induction stage? a. Intense therapy to strengthen remission b. Rapid promotion of complete remission c. Elimination of all residual leukemic cells d. Reduction of risk for central nervous system (CNS) disease

ANS: B Feedback: Induction is done to rapidly produce a complete remission. Consolidation or intensification is the stage when remission is strengthened and leukemic cell burden is reduced. Maintenance attempts to eliminate all residual leukemic cells, and CNS prophylaxis is the stage that attempts to reduce the development of CNS disease.

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

Administer the antiemetic before starting chemotherapy.

The nurse is working with a child who is in sickle cell crisis. Treatment and nursing care for this child include which actions? Select all that apply. Administering oxygen Administering analgesics Maintaining fluid intake Promoting exercise and activity Administering platelets

Administering oxygen Administering analgesics Maintaining fluid intake

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

Assessing the child's level of consciousness.

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 Brush his or her teeth Remain in an upright position for at least 15 minutes Not eat or drink for one hour

Brush his or her teeth Explanation: 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.

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

Calling the doctor if the child gets a sore throat Explanation: Calling the doctor if the child gets a sore throat is the priority. Because of the child's impaired immune system, any sign of potential infection, such as sore throat, must be evaluated by a physician. Using acetaminophen if the child needs an analgesic, writing down phone numbers and appointments, and keeping a written copy of the treatment plan are important teaching points—but secondary to guarding against infection.

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

Deferasirox Explanation: 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. Edetate 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 assesses that the client is at risk for an infection related to chemotherapy-induced immunosuppression. What will the nurse include in the teaching plan for the child and parents to help reduce this risk? Select all that apply. Have the child sleep in a single bed and room. Encourage frequent, thorough handwashing. Provide a low-carbohydrate, low-protein diet. Encourage frequent contact with multiple visitors. Cheer up the environment with fresh flowers and plants.

Have the child sleep in a single bed and room. Encourage frequent, thorough handwashing.

A school-aged child is admitted to the hospital with a vaso-occlusive sickle cell crisis. Which measure in the child's care plan should be given priority? Beginning active range-of-motion exercises Seeing that the child ingests a protein-rich diet Maintaining fluids through an intravenous line Encouraging the child to take deep breaths hourly

Maintaining fluids through an intravenous line

Which intervention is best to use with the 6-year-old who has developed stomatitis as a side effect of chemotherapy? Limit foods to cool, clear liquids Practice frequent, gentle oral hygiene Use lidocaine rinses Have the child freely choose desired foods and beverages

Practice frequent, gentle oral hygiene Explanation: Frequent, gentle oral hygiene will keep the vulnerable oral mucosa clean and will prevent secondary infection. Offering only cool, clear liquids will limit nutrition. Freely choosing foods and beverages gives some control to the 6-year-old but is likely to result in ingestion of foods that are irritating to the mouth, lips, and throat. Lidocaine used as a rinse can create risks for children younger than 8 years because often some is swallowed, and this inhibits the gag reflex.

A child diagnosed with hemophilia presents with warm, swollen, painful joints. Which action will the nurse take first? Document the presence of hemarthrosis in the client's chart Notify the client's primary health care provider Assess the client's urine and stool for blood Prepare to administer factor replacement medication

Prepare to administer factor replacement medication

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. Vigorously rub the child's gums with gauze to clean them. Provide various soft and bland foods to minimize further irritation. Have the child rinse the mouth with lukewarm water three times a day. Give the child acidic foods (e.g., orange juice) to cleanse the mouth. Apply a lip balm or petroleum jelly to prevent cracking.

Provide various soft and bland foods to minimize further irritation. Have the child rinse the mouth with lukewarm water three times a day. Apply a lip balm or petroleum jelly to prevent cracking.

A child with acute lymphoblastic leukemia (ALL) is receiving methotrexate for therapy. Which nursing diagnosis would best apply during therapy? Risk for impaired skin integrity related to oral ulcerations associated with chemotherapy Risk for impaired mobility related to depressant effects of methotrexate Excess fluid volume related to effect of methotrexate on aldosterone secretion Risk for self-directed violence related to effect of methotrexate on central nervous system

Risk for impaired skin integrity related to oral ulcerations associated with chemotherapy Explanation: Methotrexate is a chemotherapeutic agent; one of its side effects is oral mucositis. Oral ulcerations can interfere with nutrition because of pain and leave a portal for infection. Mucositis can be treated with oral swish and swallow agents or swish and spit agents (diphenhydramine, lidocaine, nystatin). Mucositis is very painful and children will not be able to eat, so alternate ways of delivering nutrition may be necessary. The child receiving methotrexate may need large volumes of hydration to prevent dehydration from the medication effects. The nursing diagnosis of fluid overload from aldosterone production would be incorrect. Methotrexate works on specific cells. It does not affect the central nervous system. The child may have decreased mobility from the cancer effects and any side effects of many drugs the child is receiving as a result of a weakened state, but methotrexate is not a depressant.

A 6-year-old child has been found to have a stage II brain tumor. The parent asks the nurse to explain what "stage II" means. Which information would the nurse provide? The cancer has spread in the brain itself but the chance of complete surgical removal is good. The tumor has not extended into the surrounding tissue and can be completely removed surgically. Cancer cells have spread to local lymph nodes. Tumors have spread systemically throughout the body.

The cancer has spread in the brain itself but the chance of complete surgical removal is good. Explanation: Knowing the stage of a tumor helps the health care team design an effective treatment program, establish an accurate prognosis, and evaluate the progress or regression of the disease. In general, stage I refers to a tumor that has not extended into the surrounding tissue so can be completely removed surgically; stage II means there is some local spread but the chance for complete surgical removal is good. S tage III typically means cancer cells have spread to local lymph nodes; stage IV designates tumors that have spread systemically (metastasis).

The nurse is reviewing the laboratory test results of a child who is receiving chemotherapy. To calculate the child's absolute neutrophil count, in addition to the total number of white blood cells, which results would the nurse use? Select all that apply. a. Bands b. Segs c. Eosinophils d. Basophils

a. Bands b. Segs Feedback: To calculate the absolute neutrophil count, the nurse would add together the percentage of banded and segmented neutrophils and then multiply the total number of white blood cells reported on the complete blood count by the sum.

A group of nursing students are reviewing the different types of chemotherapeutic agents used to treat childhood cancers. The students demonstrate understanding of the information when they identify which as antimetabolites? Select all that apply. mitoxantrone cytarabine hydroxyurea dactinomycin carboplatin

cytarabine hydroxyurea Cytarabine and hydroxyurea are antimetabolites. Mitoxantrone and dactinomycin are antitumor antibiotics. Carboplatin is a miscellaneous agent.

When planning the care for a child with leukemia who is receiving methotrexate, the nurse would assess the child closely for which possible effect? mucositis cushingoid facial appearance weight gain paresthesias of the fingers

mucositis Explanation: Mucositis, or ulcers of the gum line and mucous membranes of the mouth, is a frequent side effect of methotrexate. Cushingoid facial appearance and weight gain are associated with the use of prednisone. Paresthesias are associated with vincristine.

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: seizures. behavioral addiction. priapism. leg ulcers.

seizures

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

46. 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."

ANS: C Feedback: When giving liquid iron supplements, the liquid should be placed behind the teeth because it can stain the teeth. Iron can lead to constipation, so increased fluid and fiber intake is appropriate. The dosage needs to be measured carefully to prevent overdosing the child, leading to iron toxicity.

To prevent further sickle cell crisis, the nurse would advise the parents of a child with sickle cell anemia to: notify a health care provider if the child develops an upper respiratory infection. prevent the child from drinking an excess amount of fluids per day. 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.

To prevent further sickle cell crisis, the nurse would advise the parents of a child with sickle cell anemia to: notify a health care provider if the child develops an upper respiratory infection. prevent the child from drinking an excess amount of fluids per day. 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. Explanation: 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 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: "We should administer the drug on an empty stomach." "We should check our son's urine for glucose." "He might develop a rounded face from this drug." "We will need to gradually decrease the dosage."

"We should administer the drug on an empty stomach." Explanation: Corticosteroids are commonly administered with food to decrease the risk for gastrointestinal upset. Corticosteroids can disrupt glucose balance, so urine should be checked for glucose. A moon face is an adverse effect of corticosteroids. Corticosteroids need to be tapered gradually to reduce the risk of adrenal insufficiency.