Module 12 Saunders ?'s
A 14-year-old girl is admitted to the hospital with a diagnosis of acute lymphocytic leukemia. She is receiving a combination chemotherapeutic regimen that includes cyclophosphamide. The nurse plans care understanding that which are associated with this medication? Select all that apply. 1. It is platelet sparing. 2. It causes constipation. 3. It causes hemorrhagic cystitis. 4. It causes bone marrow depression. 5. Increased fluid intake is necessary.
1. It is platelet sparing. 3. It causes hemorrhagic cystitis. 4. It causes bone marrow depression. 5. Increased fluid intake is necessary. Cyclophosphamide is an alkylating agent used as a chemotherapeutic agent in children with leukemia and other cancers. It also causes hemorrhagic cystitis; therefore increased fluid intake is necessary. It does not cause constipation. Its side effects include bone marrow depression (BMD), but it is platelet sparing.
A child undergoes surgical removal of a brain tumor. During the postoperative period, the nurse is monitoring the child and notes that the child is restless, the pulse rate is elevated, and the blood pressure has decreased significantly from the baseline value. The nurse suspects that the child is in shock. Which is the most appropriate nursing action? 1. Notify the health care provider (HCP). 2. Place the child in a supine position. 3. Place the child in Trendelenburg's position. 4. Increase the flow rate of the intravenous fluids.
1. Notify the health care provider (HCP). In the event of shock, the HCP is notified immediately before the nurse changes the child's position or increases intravenous fluids. After craniotomy, a child is never placed in the supine or Trendelenburg's position because it increases intracranial pressure (ICP) and the risk of bleeding. The head of the bed should be elevated. Increasing intravenous fluids can cause an increase in ICP.
The nurse is monitoring a 3-year-old child for signs and symptoms of increased intracranial pressure (ICP) after a craniotomy. The nurse plans to monitor for which early sign or symptom of increased ICP? 1. Vomiting 2. Bulging anterior fontanel 3. Increasing head circumference 4. Complaints of a frontal headache
1. Vomiting The brain, although well protected by the solid bony cranium, is highly susceptible to pressure that may accumulate within the enclosure. Volume and pressure must remain constant within the brain. A change in the size of the brain, such as occurs with edema or increased volume of intracranial blood or cerebrospinal fluid without a compensatory change, leads to an increase in intracranial pressure (ICP), which may be life-threatening. Vomiting, an early sign of increased ICP, can become excessive as pressure builds up and stimulates the medulla in the brainstem, which houses the vomiting center. Children with open fontanels (posterior fontanel closes at 2 to 3 months; anterior fontanel closes at 12 to 18 months) compensate for ICP changes by skull expansion and subsequent bulging fontanels. When the fontanels have closed, nausea, excessive vomiting, diplopia, and headaches become pronounced, with headaches becoming more prevalent in older children.
a client experiencing a severe major depressive episode is unable to address activities of daily living. the appropriate nursing intervention is to: A.feed, bathe, and dress the client as needed until the client can perform these activities independently. B.offer the client choices and consequences to the failure to comply with the expectation of maintaining activities of daily living. C.structure the client's day so that adequate time can be devoted to the client's assuming responsibility for the activities of daily living D.have the client's peers confront the client about how the noncompliance in addressing activities of daily living affects the milieu.
A
Which nursing interventions are appropriate for a hospitalized client with mania who is exhibiting manipulative behavior? Select all that apply. A. Communicate expected behaviors to the client B. ensure that the client knows that he or she is not in charge of the nursing unit C. assist the client in developing means of setting limits on personal behavior D. follow through about the consequences of behavior in a nonpunitive manner E. enforce rules and inform the client that he or she will not be allowed to attend therapy groups. F. be clear with the client regarding the consequences of exceeding limits set regarding behavior
A, C, D, F
a client receiving a tricyclic antidepressent arrives at the mental health clinic. Which observation indicates that the client is correctly following the medication plan? A. reports not going to work for this past week B. complains of not being able to "do anything" anymore C. arrives at the clinic neat and appropriate in appearance D. reports sleeping 12 hours per night and 3 to 4 hours during the day
C
a client was admitted to a medical unit with acute blindness. many tests are performed and there seems to be no organic reason why this client cannot see. the nurse latter learns that the client became blind after witnessing a hit-and-run car crash, in which a family of three was killed. the nurse suspects that the client may be experiencing a: A. psychosis B. repression C. conversion disorder D. dissociative disorder
C
a client who is diagnosed with pedophilia and has been recently paroled as a sex offender says "Im in treatment and I have served my time. Now this group has posters of me all over the neighborhood telling about me with my picture on it" which of the following is an appropriate response by the nurse? A. "when children are hurt as you hurt them, people want you isolated" B. "you're lucky it doesn't escalate into something pretty scary after your crime" C. "you understand that people fear for their children, but you're feeling unfairly treated?" D. "you seem angry, but you have committed serious crimes against several children, so your neighbors are frightened?"
C
a nurse is caring for a client diagnosed with catatonic stupor. the client is lying on the bed, with the body pulled into a fetal position. the appropriate nursing intervention is which of the following? A. ask direct questions to encourage talking. B. leave the client alone and intermittently check on him. C. sit beside the client in silence and verbalize occasional open-ended questions. D. take the client into the dayroom with other clients so they can help watch him
C
a nurse notes documentation in a client's record that the client is experiencing delusions of persecution. The nurse understands that these types of delusions are characteristics of which of the following? A. the false belief that one is a very powerful person. B. the false belief that one is very important person C. the false belief that one is being singled out for harm by others D. the false belief that one's partner is going out with other people
C
a client taking buspirone (buspar) for 1 month returns to the clinic for a follow-up visit. which of the following would indicate medication effectiveness? A. no rapid heartbeats or anxiety B. no paranoid thought process C. no thought broadcasting or delusions D. no reports of alcohol withdrawal symptoms
A
a client taking lithium carbonate (Lithobid) reports vomiting, abdominal pain, diarrhea, blurred vision, tinnitus, and tremors. the lithium level is checked as part of the routine follow-up and the level is 3.0 mEq/L. the nurse knows that this level is: A. Toxic B. Normal C. Slightly above normal D. Excessively below normal
A
Your client feels responsible for his sister's death because he took her to the hospital where she died. "If I hadn't taken her there, they couldn't have killed her." It has been 1 month since her death. Is this response indicative of a normal or a complicated grief reaction?
This is a normal expression of the anger and guilt that occur.Try to minimize rumination on these thoughts.
a manic client announces to everyone in the day room that a stripper is coming to perform that evening. when the psychiatric nurse's aide firmly states that the client's behavior is not appropriate, the manic client becomes verbally abusive and threatens physical violence to the nurse's aide. Based on the analysis of this situation, the nurse determines that the appropriate action would be to: A. escort the manic client to his or her room B. orient the client to time, person, and place C. tell the client that the behavior is not appropriate D. tell the client that smoking privileges are revoked for 24 hours
A
a nurse is assisting in planning care for a client being admitted to the nursing unit who has attempted suicide. which priority nursing intervention will the nurse include in the plan of care? A. one to one suicide precautions B. suicide precautions, with 30 minute checks C .checking the whereabouts of the client every 15 minutes D. asking that the client report suicidal thoughts immediately
A
a nurse is collecting data from a client and the client's spouse reports that the client is taking donepezil hydrochloride (Aricept). which disorder would the nurse suspect that this client may have based on the use of this medication? A.dementia B.schizophrenia C.seizure disorder D.obsessive-compulsive disorder
A
a nurse observes that a client with a potential for violence is agitated, pacing up and down in the hallway, and making aggressive and belligerent gestures at other clients. which statement would be appropriate to make to this client? A."you need to stop that behavior now" B."you will need to be placed in seclusion" C.what is causing you to become agitated" D."you will need to be restrained if you do not change your behavior"
C
Identify the five stages of death and dying.
Denial, anger, bargaining, depression, acceptance
a nurse observes that a client is psychotic, pacing, and agitated and is making aggressive gestures. The client's speech pattern is rapid and the client's affect is belligerent. Based on these observations, the nurse's immediate priority of care is to: A. Provide safety for the client and other clients on the unit B. Provide the clients on the unit with a sense of comfort and safety C. Assist the staff in caring for the client in a controlled environment D. offer the client a less-stimulating area to calm down and gain control
A
Your client, an incest survivor, is speaking of her deceased father, the perpetrator. "He was a wonderful man, so good and kind. Everyone thought so." What would be the most useful intervention at this time?
Gently point out both the positive and negative aspects of her relationship with her father. Try to minimize the idealization of the deceased.
What are the priorities for a client with a Wilms tumor?
Protect the child from injury to the encapsulated tumor. Prepare the family and child for surgery.
which behaviors observed by the nurse might lead to the suspicion that a depressed adolescent client could be suicidal? A. the client gives away a prized CD and a cherished autographed picture of the performer B. the client runs out of the therapy group swearing at the group leader and then runs to her room C. the client gets angry with her roommate when the roommate borrows her clothes without asking D. the client becomes angry while speaking on the telephone and slams the receiver down on the hook.
A
a hospitalized client is started on phenelzine sulfate (Nardil) for the treatment of depression. the nurse instructs the client to avoid consuming which foods while taking this medication? Select all that apply. A. figs B. yogurt C. crackers D. aged cheese E. tossed salad F. Wine
A, B, D, F
a nurse is caring for a hospitalized client who has been taking clozapine (clozaril) for the treatment of schizophrenic disorder. which laboratory study prescribed for the client will the nurse specifically review to monitor for an adverse effect associated with the use of this medication? A. platelet count B. cholesterol level C. WBC D. Blood urea nitrogen level
C
A 4-year-old child diagnosed with leukemia is hospitalized for chemotherapy. The child is fearful of the hospitalization. Which nursing intervention should be implemented to alleviate the child's fears? 1. Encourage the child's parents to stay with the child. 2. Encourage play with other children of the same age. 3. Advise the family to visit only during the sched- uled visiting hours. 4. Provide a private room, allowing the child to bring favorite toys from home.
1 Rationale: Although the preschooler already may be spending sometime away from parents at a daycare center or preschool, illness adds a stressor that makes separation more difficult. The child may ask repeatedly when parents will be coming for a visit or may constantly want to call the parents.
The nurse analyzes the laboratory values of a child with leukemia who is receiving chemotherapy. The nurse notes that the platelet count is 19,500 mm3 (19.5 Â 10^9/L). On the basis of this laboratory result, which intervention should the nurse include in the plan of care? 1. Initiate bleeding precautions. 2. Monitor closely for signs of infection. 3. Monitor the temperature every 4 hours. 4. Initiate protective isolation precautions.
1 Rationale: Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia).
The nurse is monitoring a 3-year-old child for signs and symptoms of increased intracranial pressure (ICP) after a craniotomy. The nurse plans to mon- itor for which early sign or symptom of increased ICP? 1. Vomiting 2. Bulging anterior fontanel 3. Increasing head circumference 4. Complaints of a frontal headache
1 Rationale: The brain, although well protected by the solid bony cranium, is highly susceptible to pressure that may accu- mulate within the enclosure. Volume and pressure must remain constant within the brain.A change in the size of the brain, such as occurs with edema or increased volume of intracranial blood or cerebrospinal fluid without a compensatory change, leads to an increase in ICP, which may be life-threatening. Vomiting, an early sign of increased ICP, can become excessive as pressure builds up and stimulates the medulla in the brainstem, which housesthevomitingcenter.
The mother of a 4-year-old child tells the pediatric nurse that the child's abdomen seems to be swol- len. During further assessment, the mother tells the nurse that the child is eating well and that the activity level of the child is unchanged. The nurse, suspecting the possibility of Wilms' tumor, should avoid which during the physical assessment? 1. Palpating the abdomen for a mass 2. Assessing the urine for the presence of hematuria 3. Monitoring the temperature for the presence of fever 4. Monitoring the blood pressure for the presence of hypertension
1 Rationale: Wilms'tumor is the most common intraabdominal and kidney tumor of childhood. If Wilms'tumor is suspected, the tumor mass should not be palpated by the nurse. Excessive manipulation can cause seeding of the tumor and spread of the cancerous cells. Hematuria, fever, and hypertension are clinical manifestations associated with Wilms' tumor
383. The nurse is conducting staff in-service training on von Willebrand's disease. Which should the nurse include as characteristics of von Willebrand's disease? Select all that apply. 1. Easy bruising occurs 2. Gum bleeding occurs 3. It is a hereditary bleeding disorder 4. Treatment and care are similar to that for hemophilia 5. It is characterized by extremely high creatinine levels 6. The disorder causes platelets to adhere to damaged endothelium
1, 2, 3, 4, 6 von Willebrand's disease is a hereditary bleeding disorder characterized by a deficiency of or a defect in a protein termed von Willebrand factor. The disorder causes platelets to adhere to damaged endothelium. It is characterized by an increased tendency to bleed from mucous membranes. Assessment findings include epistaxis, gum bleeding, easy bruising, and excessive menstrual bleeding. An elevated creatinine level is not associated with this disorder.
The nurse is performing an assessment on a 10-year-old child suspected to have Hodgkin's disease. The nurse understands that which assessment findings are specifically characteristic of this disease? Select all that apply. 1. Abdominal pain 2. Fever and malaise 3. Anorexia and weight loss 4. Painful, enlarged inguinal lymph nodes 5. Painless, firm, and movable adenopathy in the cervical area
1. Abdominal pain 5. Painless, firm, and movable adenopathy in the cervical area Hodgkin's disease (a type of lymphoma) is a malignancy of the lymph nodes. Specific clinical manifestations associated with Hodgkin's disease include painless, firm, and movable adenopathy in the cervical and supraclavicular areas and abdominal pain as a result of enlarged retroperitoneal nodes. Hepatosplenomegaly also is noted. Although fever, malaise, anorexia, and weight loss are associated with Hodgkin's disease, these manifestations are seen in many disorders.
The nurse has reviewed the health care provider's prescriptions for a child suspected of a diagnosis of neuroblastoma and is preparing to implement diagnostic procedures that will confirm the diagnosis. What should the nurse expect to do next to assist in confirming the diagnosis? 1. Collect a 24-hour urine sample. 2. Perform a neurological assessment. 3. Assist with a bone marrow aspiration. 4. Send to the radiology department for a chest x-ray.
1. Collect a 24-hour urine sample. Neuroblastoma is a solid tumor found only in children. It arises from neural crest cells that develop into the sympathetic nervous system and the adrenal medulla. Typically, the tumor infringes on adjacent normal tissue and organs. Neuroblastoma cells may excrete catecholamines and their metabolites. Urine samples will indicate elevated vanillylmandelic acid (VMA) levels. A bone marrow aspiration will assist in determining marrow involvement. A neurological examination and a chest x-ray may be performed but will not confirm the diagnosis.
The mother of a 4-year-old child tells the pediatric nurse that the child's abdomen seems to be swollen. During further assessment of subjective data, the mother tells the nurse that the child is eating well and that the activity level of the child is unchanged. The nurse, suspecting the possibility of Wilms' tumor, should avoid which during the physical assessment? 1. Palpating the abdomen for a mass 2. Assessing the urine for the presence of hematuria 3. Monitoring the temperature for the presence of fever 4. Monitoring the blood pressure for the presence of hypertension
1. Palpating the abdomen for a mass Wilms' tumor is the most common intraabdominal and kidney tumor of childhood. If Wilms' tumor is suspected, the tumor mass should not be palpated by the nurse. Excessive manipulation can cause seeding of the tumor and spread of the cancerous cells. Hematuria, fever, and hypertension are clinical manifestations associated with Wilms' tumor.
The nurse is monitoring a child for bleeding after surgery for removal of a brain tumor. The nurse checks the head dressing for the presence of blood and notes a colorless drainage on the back of the dressing. Which intervention should the nurse per- form immediately? 1. Reinforce the dressing. 2. Notify the health care provider (HCP). 3. Document the findings and continue to monitor. 4. Circle the area of drainage and continue to monitor.
2 Rationale: Colorless drainage on the dressing in a child after craniotomy indicates the presence of cerebrospinal fluid and should be reported to the HCP immediately.
A 4-year-old child is admitted to the hospital for abdominal pain. The mother reports that the child has been pale and excessively tired and is bruising easily. On physical examination, lymphadenopathy and hepatosplenomegaly are noted. Diagnosticstudies are being performed because acute lymphocytic leukemia is suspected. The nurse determinesthat which laboratory result confirms the diagnosis? 1. Lumbar puncture showing no blast cells 2. Bone marrow biopsy showing blast cells 3. Platelet count of 350,000 mm3 (350 Â 10^9/L) 4. White blood cell count 4500 mm3 (4.5 Â 10^9/L)
2 Rationale: Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. The confirmatory test for leukemia is microscopic examination of bone marrow obtained by bone marrow aspirate and biopsy, which is considered positive if blast cells are present.
A 9-year-old child with leukemia is in remission and has returned to school. The school nurse calls the mother of the child and tells the mother that a classmate has just been diagnosed with chickenpox. The mother immediately calls the clinic nurse because the leukemic child has never had chickenpox. Which is an appropriate response by the clinic nurse to the mother? 1. "There is no need to be concerned." 2. "Bring the child into the clinic for a vaccine." 3. "Keep the child out of school for a 2-week period." 4. "Monitor the child for an elevated temperature, and call the clinic if this happens."
2. "Bring the child into the clinic for a vaccine." Immunocompromised children are unable to fight varicella adequately. Chickenpox can be deadly to the immunocompromised child. If an immunocompromised child who has not had chickenpox is exposed to someone with varicella, the child should receive varicella-zoster immune globulin within 96 hours of exposure. All other options are incorrect because they do nothing to minimize the chances of developing the disease.
A nurse is caring for a 9-year-old child with leukemia who is hospitalized for the administration of chemotherapy. The nurse would monitor the child specifically for central nervous system (CNS) involvement by checking which item? 1. Pupillary reaction 2. Level of consciousness (LOC) 3. The presence of petechiae in the sclera 4. Color, motion, and sensation of the extremities
2. Level of consciousness (LOC) The CNS status is monitored in the child with leukemia because of the risk of infiltration of blast cells into the CNS. The nurse should check the child's LOC and should also monitor for signs of irritability, vomiting, and lethargy. Changes in pupillary reaction are specific to conditions related to increased intracranial pressure. The presence of petechiae in the sclera is an objective sign that may be noted in leukemia but is not specifically related to the CNS. Color, motion, and sensation of the extremities relate to a neurovascular assessment and are not specifically related to CNS status.
The nurse is monitoring a child for bleeding after surgery for removal of a brain tumor. The nurse checks the head dressing for the presence of blood and notes a colorless drainage on the back of the dressing. Which intervention should the nurse perform immediately? 1. Reinforce the dressing. 2. Notify the health care provider (HCP). 3. Document the findings and continue to monitor. 4. Circle the area of drainage and continue to monitor.
2. Notify the health care provider (HCP). Colorless drainage on the dressing in a child after craniotomy indicates the presence of cerebrospinal fluid and should be reported to the HCP immediately. Options 1, 3, and 4 are not the immediate nursing intervention because they do not address the need for immediate intervention to prevent complications.
375. The nurse is providing home care instructions to the parents of a 10-year-old child with hemophilia. Which sport activity should the nurse suggest for this child? 1. Soccer 2. Basketball 3. Swimming 4. Field hockey
3 Hemophilia refers to a group of bleeding disorders resulting from a deficiency of specific coagulation proteins. Children with hemophilia need to avoid contact sports and to take precautions such as wearing elbow and knee pads and helmets with other sports. The safe activity for them is swimming.
379. A 10 y/o child with hemophilia A has slipped on the ice and bumped his knee. The nurse should prepare to administer which prescription? 1. Injection of factor X 2. Intravenous infusion of iron 3. Intravenous infusion of factor VIII 4. Intramuscular injection of iron using the Z-track method
3 Hemophilia refers to a group of bleeding disorders resulting from a deficiency of specific coagulation proteins. The primary treatment is replacement of the missing clotting factor; additional medications, such as agents to relieve pain, may be prescribed depending on the source of bleeding from the disprder. A child with hemophilia A is at risk for joint bleeding after a fall. Factor VIII would be prescribed intravenously to replace the missing clotting factor and minimize the bleeding. Factor X and iron are not used to treat children with hemophilia A.
The nurse is preparing to care for a dying client, and several family members are at the client's bed- side. Which therapeutic techniques should the nurse use when communicating with the family? Select all that apply. 1. Discourage reminiscing. 2. Make the decisions for the family. 3. Encourage expression of feelings, concerns, and fears. 4. Explain everything that is happening to all family members. 5. Touch and hold the client's or family mem- ber's hand if appropriate. 6. Be honest and let the client and family know they will not be abandoned by the nurse.
3,5,6 Rationale: The nurse must determine whether there is a spokesperson for the family and how much the client and fam- ily want to know. The nurse needs to allow the family and client the opportunity for informed choices and assist with the decision-making process if asked. The nurse should encourage expression of feelings, concerns, and fears and reminiscing. The nurse needs to be honest and let the client and family know they will not be abandoned. The nurse should touch and hold the client's or family member's hand, if appropriate.
The nurse is collecting data on a 9-year-old child suspected of having a brain tumor. Which question should the nurse ask to elicit data related to the classic symptoms of a brain tumor? 1. "Do you have trouble seeing?" 2. "Do you feel tired all the time?" 3. "Do you throw up in the morning?" 4. "Do you have headaches late in the day?"
3. "Do you throw up in the morning?" The classic symptoms of children with brain tumors are headache and morning vomiting related to the child getting out of bed. Headaches worsen on arising but improve during the day. Fatigue may occur but is a vague symptom. Visual changes may occur, including nystagmus, diplopia, and strabismus, but these signs are not the hallmark symptoms with a brain tumor.
A 6-year-old child has just been diagnosed with localized Hodgkin's disease, and chemotherapy is planned to begin immediately. The mother of the child asks the nurse why radiation therapy was not prescribed as a part of the treatment. What is the nurse's best response? 1. "It's very costly, and chemotherapy works just as well." 2. "I'm not sure. I'll discuss it with the health care provider." 3. "Sometimes age has to do with the decision for radiation therapy." 4. "The health care provider would prefer that you discuss treatment options with the oncologist."
3. "Sometimes age has to do with the decision for radiation therapy." Radiation therapy is usually delayed until a child is 8 years old, whenever possible, to prevent retardation of bone growth and soft tissue development. Options 1, 2, and 4 are inappropriate responses to the mother and place the mother's question on hold.
A 6-year-old child with leukemia is hospitalized and is receiving combination chemotherapy. Laboratory results indicate that the child is neutropenic, and protective isolation procedures are initiated. The grandmother of the child visits and brings a fresh bouquet of flowers picked from her garden and asks the nurse for a vase for the flowers. Which response should the nurse provide to the grandmother? 1. "I have a vase in the utility room, and I will get it for you." 2. "I will get the vase and wash it well before you put the flowers in it." 3. "The flowers from your garden are beautiful, but should not be placed in the child's room at this time." 4. "When you bring the flowers into the room, place them on the bedside stand as far away from the child as possible."
3. "The flowers from your garden are beautiful, but should not be placed in the child's room at this time." Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia). For a hospitalized neutropenic child, flowers or plants should not be kept in the room because standing water and damp soil harbor Aspergillus and Pseudomonas aeruginosa, to which the child is susceptible. In addition, fresh fruits and vegetables harbor molds and should be avoided until the white blood cell count increases.
The nurse is monitoring for bleeding in a child following surgery for removal of a brain tumor. The nurse checks the head dressing and notes the presence of dried blood on the back of the dressing. The child is alert and oriented, and the vital signs and neurological signs are stable. Which nursing action is most appropriate initially? 1. Prepare to change the dressing. 2. Recheck the dressing in 1 hour. 3. Check the operative record to determine whether a drain is in place. 4. Document the findings and notify the health care provider immediately.
3. Check the operative record to determine whether a drain is in place. The initial nursing action is to determine whether a drain is in place because this could attribute to the drainage seen on the dressing. The nurse would not change the dressing without a health care provider's prescription. Rechecking the dressing is an appropriate action, but it is not the initial action. The findings would be documented however there is no reason to notify the health care provider immediately. The initial action would be to assess the cause of the drainage further.
The nurse is reviewing the laboratory and diagnostic test results of a child scheduled to be seen in the clinic. The nurse notes that the health care provider documented that diagnostic studies revealed the presence of Reed-Sternberg cells. The nurse prepares to assist the health care provider to discuss treatment options for which disease with the parents? 1. Leukemia 2. Neuroblastoma 3. Hodgkin's disease 4. Infectious mononucleosis
3. Hodgkin's disease Hodgkin's disease is a neoplasm of lymphatic tissue. The presence of giant, multinucleated cells (Reed-Sternberg cells) is the hallmark of this disease. The presence of blast cells in the bone marrow is indicative of leukemia. Infectious mononucleosis and Epstein-Barr virus have been associated with Hodgkin's disease, but the exact relationship is unknown. Elevated vanillylmandelic acid (VMA) urinary levels are found in children with neuroblastoma.
378. The clinic nurse instructs parents of a child with sickle cell anemia about the precipitating factors related to sickle cell crisis. Which, if identified by the parents as a precipitating factor, indicates the need for further instructions? 1. Stress 2. Trauma 3. Infection 4. Fluid overload
4 Sickle cell crises are acute exacerbations of the disease, which vary considerably in severity and frequency; these include vaso-occlusive crisis, splenic sequestration, hyperhemolytic crisis, and aplastic crisis. Sickle cell crisis may be precipitated by infection, dehydration, hypoxia, trauma, or physical/emotional stress. The mother of a child with sickle cell disease should encourage fluid intake of 1 1/2 to 2 times the daily requirement to prevent dehydration.
a client is unwilling to go out of the house for fear of "doing something crazy in public". Because of this fear, the client remains homebound except when accompanied outside by the spouse. The nurse determines that the client has: A. agoraphobia B. hematophobia C. claustrophobia D. hypochondriasis
A
The pediatric nurse assists the health care provider in performing a lumbar puncture (LP) on a 3-year-old child with leukemia and suspected central nervous system metastasis. The nurse should place the child in which position for this procedure? 1. Lithotomy position 2. Modified Sims position 3. Prone, with the knees flexed to the abdomen and the head bent, the chin resting on the chest 4. Lateral recumbent, with the knees flexed to the abdomen and the head bent, the chin resting on the chest
4. Lateral recumbent, with the knees flexed to the abdomen and the head bent, the chin resting on the chest A lateral recumbent position, with the knees flexed to the abdomen and the head bent with the chin resting on the chest, is assumed for a lumbar puncture. This position separates the spinal processes and facilitates needle insertion into the subarachnoid space. The remaining options are incorrect positions.
A nurse is reviewing the record of a 10-year-old child suspected of having Hodgkin's disease. Which characteristic manifestation should the nurse anticipate to be documented in the assessment notes? 1. Fever 2. Malaise 3. Painful lymph nodes in the supraclavicular area 4. Painless and movable lymph nodes in the cervical area
4. Painless and movable lymph nodes in the cervical area Clinical manifestations specifically associated with Hodgkin's disease include painless, firm, and movable adenopathy in the cervical and supraclavicular area. Hepatosplenomegaly is also noted. Although anorexia, weight loss, fever, and malaise are associated with Hodgkin's disease, these manifestations are vague and can be seen in many disorders.
an older client is a victim of elder abuse, and the client's family has been attending weekly counseling sessions. Which statement by the abusive family member would indicate the client has learned positive coping skills? A."i will be more careful to make sure that my father's needs are met" B."now that my father is moving into my home, I will need to change my ways" C."i feel better able to care for my father now that I know where to obtain assistance" D."I am so sorry and embarrassed that the abusive event occurred. It won't happen again."
C
a nurse is preparing to care for a dying client, and several family members are at the client's bedside. Which therapeutic techniques should the nurse use when communicating with the family? Select all that apply. A. Discourage reminiscing B. make the decisions for the family C. encourage expression of feelings, concerns, and fears D. explain everything that is happening to all family members E. extend touch and hold the client's or family member's hand if appropriate F. Be honest and truthful and let the client family know that you will not abandon them.
C, E, F
Mrs. Green lost her husband 3 years ago. She has not disturbed any of his belongings and continues to set a place at the table for him nightly. Is this response indicative of a normal or a complicated grief reaction?
This is a dysfunctional grief reaction. Mrs. Green has never moved out of the denial stage of her grief work.
A nurse is caring for a client with a diagnosis of depression. the nurse monitors for signs of constipation and urinary retention, knowing that these problems are likely caused by: A. poor dietary choices B. lack of exercise and poor diet C. inadequate dietary intake and dehydration D. psychomotor retardation and side effects of medication
D
Disulfiram (Antabuse) is prescribed for a client who is seen in the psychiatric health care clinic. the nurse is collecting data on the client and is providing instructions regarding the use of this medication. Which is most important for the nurse to determine before administration of this medication? A.a history of hyperthyroidism B.a history of diabetes insipid us C.when the last full meal was consumed D.when the last alcoholic drink was consumed
D
a client is admitted to the in-patient unit and is being considered for electroconvulsive therapy (ECT). The client appears calm, but the family is hypervigilant and anxious. the client's mother begins to cry and states, "my child's brain will be destroyed. How can the doctor do this?" the nurse makes which therapeutic response? A. "it sounds as though you need to speak to the psychiatrist." B. "perhaps you'd like to see the ECT room and speak to the staff" C. your child has decided to have this treatment. you should be supportive of the decision" D. it sounds as though you have some concerns about the ECT procedure. Why don't we sit down together and discuss any concerns you may have?"
D
a nurse is caring for an older adult client who has recently lost her husband. The client says, "no one cares about me anymore. All the people I loved are dead." Which response by the nurse is therapeutic? A. "right! why not just pack it in?" B. "that seems rather unlikely to me" C. "i don't believe that, and neither do you" D. "you must be feeling all alone at this point"
D
a nurse is planning care for a client who is being hospitalized because the client has been displaying violent behavior and is at risk for potential harm to others. The nurse avoids which intervention in the plan of care? A. facing the client when providing care B. ensuring that a security officer is within the immediate area C. keeping the door to the client's room open when with the client D. assigning the client to a room at the end of the hall to prevent disturbing the other clients.
D
Nursing care of the child with myelosuppression from leukemia or chemotherapeutic agents should include which intervention? 1. Restrict oral fluids. 2. Use good hand washing technique. 3. Give immunizations appropriate for age. 4. Institute strict isolation with no visitors allowed.
2. Use good hand washing technique. A child with myelosuppression is at risk for infection. Good hand washing technique is necessary to prevent the spread of infection. Restricting oral fluids would not be an intervention to reduce the risk of infection and could actually be harmful to the child. Live virus vaccines are not given when the child is myelosuppressed, so assessment of the child's immune status should be done before administration of immunizations appropriate for age. Strict isolation without visitors is not warranted, although visitors should wear a mask and gloves while in the child's room.
382. The nurse is reviewing a health care provider's prescriptions for a child with sickle cell anemia who was admitted to the hospital for the treatment of vaso-occlusive crisis. Which prescriptions documented in the child's record should the nurse question? Select all that apply. 1. Restrict fluid intake 2. Position for comfort 3. Avoid strain on painful joints 4. Apply nasal oxygen at 2 L/min 5. Provide a high-calorie, high-protein diet 6. Give meperidine (Demerol) 25 mg intravenously every 4 hours for pain
1 Restrict fluid intake 6 Give meperidine (Demerol) 25 mg intravenously every 4 hours for pain Sickle cell anemia is one of a group of diseases termed hemoglobinopathies, in which hemoglobin A is partly or completely replaced by abnormal sickle hemoglobin S. It is caused by the inheritance of a gene for a structurally abnormal portion of the hemoglobin chain. Hemoglobin S is sensitive to changes in the oxygen content of the RBC; insufficient oxygen causes the cells to assume a sickle shape, and the cells become rigid and clumped together, obstructing capillary blood flow. Oral and intravenous fluids are an important part of treatment. Meperidine (Demerol) is not recommended for a child with sickle cell disease because of the risk for normeperidine-induced seizures. Normeperidine, a metabolite of meperidine, is a central nervous system stimulant that produces anxiety, tremors, myoclonus, and generalized seizures when it accumulates with repetitive dosing. The nurse would question the prescription for restricted fluids and meperidine for pain control. Positioning for comfort, avoiding strain on painful joints, oxygen, and a high-calorie and high-protein diet are also important parts of the treatment plan.
382. The nurse is reviewing a health care provider's prescriptions for a child with sickle cell anemia who was admitted to the hospital for the treatment of vaso-occlusive crisis. Which prescriptions documented in the child's record should the nurse question? Select all that apply. 1. Restrict fluid intake 2. Position for comfort 3. Avoid strain on painful joints 4. Apply nasal oxygen at 2 L/min 5. Provide a high-calorie, high-protein diet 6. Give meperidine (Demerol) 25 mg intravenously every 4 hours for pain
1, 6 Sickle cell anemia is one of a group of diseases termed hemoglobinopathies, in which hemoglobin A is partly or completely replaced by abnormal sickle hemoglobin S. It is caused by the inheritance of a gene for a structurally abnormal portion of the hemoglobin chain. Hemoglobin S is sensitive to changes in the oxygen content of the RBC; insufficient oxygen causes the cells to assume a sickle shape, and the cells become rigid and clumped together, obstructing capillary blood flow. Oral and intravenous fluids are an important part of treatment. Meperidine (Demerol) is not recommended for a child with sickle cell disease because of the risk for normeperidine-induced seizures. Normeperidine, a metabolite of meperidine, is a central nervous system stimulant that produces anxiety, tremors, myoclonus, and generalized seizures when it accumulates with repetitive dosing. The nurse would question the prescription for restricted fluids and meperidine for pain control. Positioning for comfort, avoiding strain on painful joints, oxygen, and a high-calorie and high-protein diet are also important parts of the treatment plan.
The nurse instructs the parents of a child with leukemia regarding measures related to monitoring for infection. Which statement, if made by the parent, indicates a need for further instructions? 1. "I will take a rectal temperature daily." 2. "I will inspect the skin daily for redness." 3. "I will inspect the mouth daily for lesions." 4. "I will perform proper hand washing techniques."
1. "I will take a rectal temperature daily." Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. The risk of injury to fragile mucous membranes is so high in the child with leukemia that tympanic or axillary temperatures should be taken. Rectal abscesses can occur easily to damaged rectal tissue. No rectal temperatures should be taken. In addition, oral temperature taking should be avoided, especially if the child has oral ulcers. All other options are appropriate measures to prevent infection.
A child undergoes surgical removal of a brain tumor. During the postoperative period, the nurse notes that the child is restless, the pulse rate is ele- vated, and the blood pressure has decreased signif- icantly from the baseline value. The nurse suspects that the child is in shock. Which is the most appro- priate nursing action? 1. Place the child in a supine position. 2. Notify the health care provider (HCP). 3. Place the child in Trendelenburg position. 4. Increase the flow rate of the intravenous fluids.
2 Rationale: In the event of shock, the HCP is notified immedi- ately before the nurse changes the child's position or increases intravenous fluids. After craniotomy, a child is never placed in the supine or Trendelenburg position because it increases intra- cranial pressure (ICP) and the risk of bleeding. The head of the bed should be elevated. Increasing intravenous fluids can cause an increase in ICP.
The nurse is caring for a 3-year-old boy with a diagnosis of acute lymphocytic leukemia (ALL). The child is crying and complaining that his knees hurt. Which nursing intervention is most appropriate? 1. Involve the child in a diversional activity. 2. Ask the child if he would like a "baby aspirin." 3. Administer acetaminophen (Tylenol) to the child. 4. Apply heat to the child's knees and elevate the knees on a pillow.
3. Administer acetaminophen (Tylenol) to the child. Acetaminophen is acceptable and does not have anticoagulant properties. Diversional activities would not relieve the pain. Aspirin is not administered to the child with ALL because of its anticoagulant properties and administering aspirin could lead to bleeding in the joints. Heat also would increase the pain by increasing circulation to the area.
A 4-year-old child is admitted to the hospital for abdominal pain. The mother reports that the child has been pale and excessively tired and is bruising easily. On physical examination, lymphadenopathy and hepatosplenomegaly are noted. Diagnostic studies are being performed on the child because acute lymphocytic leukemia is suspected. The nurse understands that which diagnostic study should confirm this diagnosis? 1. Platelet count 2. Lumbar puncture 3. Bone marrow biopsy 4. White blood cell count
3. Bone marrow biopsy Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. The confirmatory test for leukemia is microscopic examination of bone marrow obtained by bone marrow aspirate and biopsy. A lumbar puncture may be done to look for blast cells in the spinal fluid that indicate central nervous system disease. The white blood cell count may be normal, high, or low in leukemia. An altered platelet count occurs as a result of the disease, but also may occur as a result of chemotherapy and does not confirm the diagnosis.
The pediatric nurse clinician is discussing the pathophysiology related to childhood leukemia with a class of nursing students. Which statement made by a nursing student indicates a lack of understanding of the pathophysiology of this disease? 1. The platelet count is decreased. 2. Red blood cell production is affected. 3. Reed-Sternberg cells are found on biopsy. 4. Normal bone marrow is replaced by blast cells.
3. Reed-Sternberg cells are found on biopsy. In leukemia, normal bone marrow is replaced by malignant blast cells. As the blast cells take over the bone marrow, eventually red blood cell and platelet production is affected, and the child becomes anemic and thrombocytopenic. The Reed-Sternberg cell is found in Hodgkin's disease.
381. Laboratory studies are performed for a child suspected to have iron deficiency anemia. The nurse reviews the laboratory results, knowing that which result indicates this type of anemia? 1. Elevated hemoglobin level 2. Decreased reticulocyte count 3. Elevated red blood cell count 4. Red blood cells that are microcytic and hypochromic
4 In iron deficiency anemia, iron stores are depleted, resulting in a decreased supply of iron for the manufacture of hemoglobin in RBCs. The results of a complete blood cell count in children with iron deficiency anemia show decreased hemoglobin levels and microcytic and hypochromic red blood cells. The red blood cell count is decreased. The reticulocyte count is usually normal or slightly elevated.
a client has reported that crying spells have been a major problem over the past several weeks, and that the doctor said that depression is probably the reason. The nurse observes that the client is sitting slumped in the chair and the clothes that the client is wearing do not fit well. The nurse interprets that further data collection should focus on: A. weight loss B. sleep patterns C. medication compliance D. onset of the crying spells
A
377. A child with beta-thalassemia is receiving long-term blood transfusion therapy for the treatment of the disorder. Chelation therapy is prescribed as a result of too much iron from the transfusions. Which medication should the nurse anticipate to be prescribed? 1. Fragmin 2. Meropenem (Merrem) 3. Metoprolol (Toprol-XL) 4. Deferoxamine (Desferal)
4 Beta-thalassemia is an autosomal recessive disorder characterized by the reduced production of one of the globin chains in the synthesis of hemoglobin (both parents must be carriers to produce a child with beta-thalassemia major). The major complication of long-term transfusion therapy is hemosiderosis. to prevent organ damage from too much iron, chelation therapy with either Exhade of deferoxamine (Desferal) may be prescribed. Deferoxamine is classified as an antidote for acute iron toxicity. Fragmin is an anticoagulant used as prophylaxis for postop DV. Meropenem is an antibiotic. Metoprolol is a beta blocker used to treat hypertension
a nurse is gathering data from a client in crisis. when determining the client's perception of the precipitating event that led to the crisis, the most appropriate question to ask is: A."with whom do you live?" B."who is available to help you?' C."what leads you to seek help now?" D."what do you usually do to feel better?"
C
a nurse is preparing for the hospital discharge of a client with a history of command hallucinations to harm self or others. The nurse instructs the client about about interventions for hallucinations and anxiety and determines that the client understands the interventions when the client states: A. "my medications won't make me anxious" B. "I'll go to a support group and talk so that I won't hurt anyone." C. "I won't get anxious or hear things if I get enough sleep and eat well" D. "I can call my therapist when I'm hallucinating so that I can talk about my feelings and plans and not hurt anyone"
D
during a conversation with a depressed client on psychiatric unit, the client says to the nurse, "My family would be better off without me" the nurse should make which therapeutic response to the client? A."have you talked to your family about this?" B."everyone feels this way when they are depressed" C."you will feel better once your medication begins to work" D."you sound very upset. are you thinking of hurting yourself?"
D
A client has been told of a positive breast biopsy report. She asks no questions and leaves the health care provider's office. She is overheard telling her husband, "The doctor didn't find a thing." What coping style is operating at this stage of grief?
Denial
A client with delirium becomes agitated and confused at night. The best initial intervention by the nurse is to: A. move the client next to the nurse's station B. use a night light and turn off the television C. keep up the television and a soft light on during the night. D. play soft music during the night and maintain a well-lit room
B
a mother of a teenage client with an anxiety disorder is concerned about her daughter's progress on discharge. She states that her daughter "stashes food, eats all the wrong things that make her hyperactive" and "hangs out with the wrong crowd". In helping the mother prepare for her daughter's discharge, the nurse suggests that the mother: A. restrict the daughters socializing time with her friends. B. restrict the amount of chocolate and caffeine products in the home C. keep her daughter out of school until she can adjust to the school environment D. consider taking time from work to help her daughter readjust to the home environment.
B
a nurse is caring for a client with severe depression. Which of the following activities would be appropriate for this client? A. a puzzle B. drawing C. checkers D. paint by number
B
a nurse is performing a follow-up teaching session with a client discharged 1 month ago who is taking fluoxetine (prozac) what information would be important for the nurse to gather regarding the adverse effects related to the medication? A. cardiovascular symptoms B. gastrointestinal dysfunctions C. problem with mouth dryness D. problems with excessive sweating
B
the police arrive at the emergency room with a client who has seriously lacerated both wrists. the initial nursing action is to: A. administer an anti anxiety agent B. examine and treat the wound sites C. secure and record a detailed history D. encourage and assist the client to vent feelings
B
376. The nursing student is presenting a clinical conference and discusses the cause of beta-thalassemia. The nursing student informs that a child at greatest risk of developing this disorder is which one? 1. A child of Mexican descent 2. A child of Mediterranean descent 3. A child whose intake of iron is extremely poor 4. A breast-fed child of a mother with chronic anemia
2 Beta-thalassemia is an autosomal recessive disorder characterized by the reduced production of one of the globin chains in the synthesis of hemoglobin (both parents must be carriers to produce a child with beta-thalassemia major), This disorder is found primarily in individuals of Mediterranean descent.
The nurse is providing home care instructions to the mother of a child receiving radiation therapy. Which statement by the mother indicates a need for further teaching? 1. "I should dress my child in loose-fitting clothing." 2. "I won't need to limit the amount of sun that my child gets." 3. "My child may experience fatigue and need more rest periods." 4. "I need to try to provide food and fluids to prevent dehydration."
2. "I won't need to limit the amount of sun that my child gets." Sun protection is essential during radiation treatments. The child should not be exposed to sun during these treatments because of the risk of an alteration of skin integrity. Options 1, 3, and 4 are appropriate measures for the child during radiation therapy.
A 6-year-old child has just been diagnosed with localized Hodgkin's disease, and chemotherapy is planned to begin immediately. The mother of the child asks the nurse why radiation therapy was not prescribed as a part of the treatment. Which is the appropriate and supportive response to the mother? 1. "The child is too young to have radiation therapy." 2. "It's very costly, and chemotherapy works just as well." 3. "I'm not sure. I'll discuss it with the health care provider." 4. "The health care provider (HCP) would prefer that you discuss treatment options with the oncologist."
1. "The child is too young to have radiation therapy." Radiation therapy is usually delayed until a child is 8 years of age, if possible to prevent retardation of bone growth and soft tissue development. The remaining options are inappropriate responses to the mother.
The nurse analyzes the laboratory values of a child with leukemia who is receiving chemotherapy. The nurse notes that the platelet count is 19,500 cells/mm3. On the basis of this laboratory result, which intervention should the nurse include in the plan of care? 1. Initiate bleeding precautions. 2. Monitor closely for signs of infection. 3. Monitor the temperature every 4 hours. 4. Initiate protective isolation precautions.
1. Initiate bleeding precautions. Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia). If a child is severely thrombocytopenic and has a platelet count less than 20,000 cells/mm3, bleeding precautions need to be initiated because of the increased risk of bleeding or hemorrhage. Precautions include limiting activity that could result in head injury, using soft toothbrushes, checking urine and stools for blood, and administering stool softeners to prevent straining with constipation. In addition, suppositories, enemas, and rectal temperatures are avoided. Options 2, 3, and 4 are related to the prevention of infection rather than bleeding.
The pediatric nurse specialist provides a teaching session to the nursing staff regarding osteosarcoma. Which statement by a member of the nursing staff indicates a need for information? 1. "The femur is the most common site of this sarcoma." 2. "The child does not experience pain at the primary tumor site." 3. "Limping, if a weight-bearing limb is affected, is a clinical manifestation." 4. "The symptoms of the disease in the early stage are almost always attributed to normal growing pains."
2. "The child does not experience pain at the primary tumor site." Osteosarcoma is the most common bone cancer in children. Cancer usually is found in the metaphysis of long bones, especially in the lower extremities, with most tumors occurring in the femur. Osteosarcoma is manifested clinically by progressive, insidious, and intermittent pain at the tumor site. By the time these children receive medical attention, they may be in considerable pain from the tumor. Options 1, 3, and 4 are accurate regarding osteosarcoma.
A 13-year-old child is diagnosed with Ewing's sarcoma of the femur. After a course of radiation and chemotherapy, it was decided that leg amputation is necessary. After the amputation, the child becomes very frightened because of aching and cramping felt in the missing limb. Which nursing statement is most appropriate to assist in alleviating the child's fear? 1. "The pain medication that I give you will take these feelings away." 2. "This aching and cramping is normal and temporary and will subside." 3. "This pain is not real pain, and relaxation exercises will help it go away." 4. "This normally occurs after the surgery, and we will teach you ways to deal with it."
2. "This aching and cramping is normal and temporary and will subside." After amputation, phantom limb pain is a temporary condition that some children experience. This sensation of burning, aching, or cramping in the missing limb is distressing to the child. The child needs to be reassured that the condition is normal and only temporary. All other options are not appropriate responses to the child, as they are incorrect or inappropriate statements.
a nurse is reviewing the health care record of a client admitted to the psychiatric unit. the nurse notes that the admission nurse has documented that the client is experiencing anxiety as a result of a situational crisis. the nurse would determine that this type of crisis could be caused by: A. witnessing a murder B. the death of a loved one C. a fire that destroyed the client's home D. a recent rape episode experienced by the client.
B
Which specific nursing interventions are implemented in the care of a child with leukemia who is at risk for infection? Select all that apply. 1. Maintain the child in a semiprivate room. 2. Reduce exposure to environmental organisms. 3. Use strict aseptic technique for all procedures. 4. Ensure that anyone entering the child's room wears a mask. 5. Apply firm pressure to a needle stick area for at least 10 minutes
2. Reduce exposure to environmental organisms. 3. Use strict aseptic technique for all procedures. 4. Ensure that anyone entering the child's room wears a mask. Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia). A common complication of treatment for leukemia is overwhelming infection secondary to neutropenia. Measures to prevent infection include the use of a private room, strict aseptic technique, restriction of visitors and health care personnel with active infection, strict hand-washing, ensuring that anyone entering the child's room wears a mask, and reducing exposure to environmental organisms by eliminating raw fruits and vegetables from the diet and fresh flowers from the child's room and by not leaving standing water in the child's room. Applying firm pressure to a needle stick area for at least 10 minutes is a measure to prevent bleeding.
A 6-year-old child with leukemia is hospitalized and is receiving combination chemotherapy. Lab- oratory results indicate that the child is neutropenic, and protective isolation procedures are initiated. The grandmother of the child visits and brings a fresh bouquet of flowers picked from her garden, and asks the nurse for a vase for the flowers. Which response should the nurse provide to the grandmother? 1."I have a vase in the utility room, and I will get it for you." 2. "I will get the vase and wash it well before you put the flowers in it." 3. "The flowers from your garden are beautiful, but should not be placed in the child's room at this time." 4. "When you bring the flowers into the room, place them on the bedside stand as far away from the child as possible."
3 Rationale: Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing anemia from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production (thrombocytopenia). For a hospitalized neutropenic child,flowers or plants should not be kept in the room because standing water and damp soil harbor Aspergillus and Pseudomonas aeruginosa, to which the child is suscep- tible. In addition, fresh fruits and vegetables harbor molds and should be avoided until the white blood cell count increases.
A diagnostic workup is being performed on a 1-year-old child with suspected neuroblastoma. The nurse reviews the results of the diagnostic tests and understands that which finding is most specifically related to this type of tumor? 1. Positive Babinski's sign 2. Presence of blast cells in the bone marrow 3. Projectile vomiting, usually in the morning 4. Elevated vanillylmandelic acid (VMA) urinary levels
4. Elevated vanillylmandelic acid (VMA) urinary levels Neuroblastoma is a solid tumor found only in children. It arises from neural crest cells that develop into the sympathetic nervous system and the adrenal medulla. Typically, the tumor compresses adjacent normal tissue and organs. Neuroblastoma cells may excrete catecholamines and their metabolites. Urine samples will indicate elevated VMA levels. The presence of blast cells in the bone marrow occurs in leukemia. Projectile vomiting occurring most often in the morning and a positive Babinski's sign are clinical manifestations of a brain tumor.
The nurse is asked to prepare for the admission of a child to the pediatric unit with a diagnosis of Wilms' tumor. The nurse is developing a plan of care for the child and should include which intervention in the plan? 1. Monitor the temperature for hypothermia. 2. Monitor the blood pressure for hypotension. 3. Palpate the abdomen for an increase in the size of the tumor. 4. Inspect the urine for the presence of hematuria at each voiding.
4. Inspect the urine for the presence of hematuria at each voiding. If Wilms' tumor is suspected, the tumor mass should not be palpated. Excessive manipulation can cause seeding of the tumor and cause spread of the cancerous cells. Fever (not hypothermia), hematuria, and hypertension (not hypotension) are clinical manifestations associated with Wilms' tumor.
A child is scheduled for allogeneic bone marrow transplantation (BMT). The parent of the child asks the nurse about the procedure. The nurse should provide which description about the BMT transplantation? 1. Aspiration of bone marrow from the child 2. Obtaining bone marrow from the child's twin 3. Obtaining bovine (cow) bone marrow and administering it to the child 4. Obtaining bone marrow from a donor who matches the child's tissue type
4. Obtaining bone marrow from a donor who matches the child's tissue type In allogeneic BMT, a donor who matches the child's tissue type is found. That bone marrow is then given to the child. In autologous BMT, the child undergoes general anesthesia for aspiration of his or her bone marrow, which is then processed in the laboratory and frozen until that marrow needs to be infused back into the child. Syngeneic BMT is done when the child has an identical twin. Option 3 is not used in a BMT.
374. The nurse analyzes the laboratory results of a child with hemophilia. The nurse understands that which result will most likely be abnormal in this child? 1. Platelet count 2. Hematocrit level 3. Hemoglobin level 4. Partial thromboplastin time (PTT)
4. Partial thromboplastin time Hemophilia refers to a group of bleeding disorders resulting from a deficiency of specific coagulation proteins. Results of tests that measure platelet function are normal; results of tests that measure clotting factor function may be abnormal. Abnormal laboratory results in hemophilia indicate a prolonged partial thromboplastin time. The platelet count, hemoglobin level, and hematocrit level are normal in hemophilia.
A diagnosis of Hodgkin's disease is suspected in a 12-year-old child seen in a clinic. Several diagnostic studies are performed to determine the presence of this disease. Which diagnostic test result will confirm the diagnosis of Hodgkin's disease? 1. Elevated vanillylmandelic acid urinary levels 2. The presence of blast cells in the bone marrow 3. The presence of Epstein-Barr virus in the blood 4. The presence of Reed-Sternberg cells in the lymph nodes
4. The presence of Reed-Sternberg cells in the lymph nodes Hodgkin's disease (a type of lymphoma) is a malignancy of the lymph nodes. The presence of giant, multinucleated cells (Reed-Sternberg cells) is the classic characteristic of this disease. Elevated levels of vanillylmandelic acid in the urine may be found in children with neuroblastoma. The presence of blast cells in the bone marrow indicates leukemia. Epstein-Barr virus is associated with infectious mononucleosis.
Nursing interventions and medical treatments for a child with leukemia are based on what three physiologic problems?
Anemia (decreased erythrocytes); infection (neutropenia); bleeding thrombocytopenia (decreased platelets)
A nurse is collecting data on a client who is actively hallucinating. Which nursing statement would be therapeutic at this time? A."I know you feel they are out to get you, but its not true" B."I can hear the voice and she wants you to come to dinner" C."sometimes people hear things or voices others can't hear" D."I talked to the voices you're hearing and they won't hurt you now"
C
Fluoxetine (Prozac) is prescribed for the client. the nurse reinforces instructions to the client regarding the administration of the medication. Which statement by the client indicates an understanding about administration of the medication? A."I should take the medication with my evening meal" B."i should take the medication at noon with an antacid" C."I should take the medication in the morning when i first arise" D.I should take the medication right before bed time with a snack"
C
a client arrives at the health care clinic and tells the nurse that he has been doubling his daily dosage of buprotion hydrochloride (Wellbutrin) to help him get better faster. The nurse understands that the client is now at risk for which of the following? A. insomnia B. weight gain C. seizure activity D. orthostatic hypotension
C
a client is admitted to the psychiatric unit after a serious suicidal attempt by hanging. the nurse's most important aspect of care is to maintain client safety and plans to: A. request that a peer remain with the client at all times B. remove the client's clothing and place the client in a hospital gown. C. assign a staff member to the client who will remain with him or her at all times D. admit the client to a seclusion room where all potentially dangerous articles are removed
C
a nurse is assisting in developing a plan of care for the client in a crisis state. when developing the plan, the nurse will consider which of the following? A. a crisis state indicates that the individual is suffering from a mental illness B. a crisis state indicates that the individual is suffering from an emotional illness C. Presenting symptoms in a crisis situation are similar for all individuals experiencing a crisis. D. a client's response to a crisis is individualized, and what constitutes a crisis for one person may not constitute a crisis for another person.
D
