PEDs Chapter 46: heme
The nurse is preparing to post a sign above the crib of an infant with a Wilms tumor. Which statement should the nurse post? "Do not palpate abdomen." "No milk or milk products allowed." "No blood sampling in lower extremities." "No intramuscular injections."
"Do not palpate abdomen." Explanation: When an infant has a Wilms tumor, It is important that the infant's abdomen not be palpated more than is necessary for diagnosis, because handling appears to aid metastasis. The nurse will post a sign reading "No Abdominal Palpation" over the infant's crib to help prevent palpation. Intramuscular injections, milk products, or blood sampling in the lower extremities are not contraindicated for this health problem
A nurse is conducting a class to a group of parents on sickle cell anemia. Which statement by a parent indicates teaching has been effective? "This is a hereditary disease that is transmitted by one affected gene." "The sickle shape of red blood cells decreases oxygen to tissues." "Fluid restriction is necessary to control sickle cell anemia." "Sickle cell anemia is common in people of Asian descent."
"The sickle shape of red blood cells decreases oxygen to tissues." Explanation: The sickle shape of the red blood cells impedes the flow of blood through the vessels, thus causing hypoxia to the tissues. Sickle cell anemia is a hereditary disease but it is autosomal recessive, meaning it requires two genes in order for the disease to be transmitted. Sickle cell anemia is common in people of African, Mediterranean, and Indian descent. Hydration is important to controlling sickle cell anemia. Dehydration is a trigger for sickle cell crisis.
A nurse is giving instructions to the father of a boy who is receiving chemotherapy (including methotrexate) regarding how best to care for the boy during this period of treatment. What should the nurse mention to him? You Selected: Keep him away from people with known infections
A child receiving chemotherapy is particularly susceptible to contracting an infection so should be kept away from people with known infections. Caution parents not to give aspirin for pain to children receiving chemotherapy; in addition to increasing the child's susceptibility to Reye syndrome, aspirin may interfere with blood coagulation, a problem that may already be present because of lowered thrombocyte levels. A parent who wants to give a child vitamins should check with the primary health care provider to be certain the vitamin preparation will not interfere with a chemotherapeutic agent. Administration of a vitamin that contains folic acid, for example, could interfere with the effectiveness of methotrexate, a folic acid antagonist. Caution parents that live-virus vaccines should not be given during chemotherapy as these vaccines could cause widespread viral disease if the child's immune mechanism is deficient.
The nurse is concerned that a school-aged child has iron-deficiency anemia. What did the nurse assess in this client? Asking many questions Shyness Craving for ice cubes Thumb-sucking
Craving for ice cubes Explanation: In school-aged children, there is an association between iron-deficiency anemia and pica or the craving for ice cubes. Iron-deficiency anemia is not associated with shyness, thumb-sucking, or inquisitive behavior.
A nurse is administering a blood transfusion to a child. About 35 minutes after beginning the transfusion, the child develops pruritus and urticaria. Some wheezing is noted. Which action would the nurse take first? Ask the health care provide for a prescription for a diuretic. Give an iron-chelating agent. Discontinue the transfusion. Obtain a blood culture.
Discontinue the transfusion. The child is experiencing a transfusion reaction; the first step with any transfusion reaction is to discontinue the transfusion. Oxygen should be given, and the nurse should anticipate the need for an antihistamine to reduce the child's symptoms. An iron-chelating agent would be given for hemosiderosis after repeated transfusions. A blood culture would be obtained if the child developed a fever.
The nurse is instructing the parents of a child with sickle cell anemia on safety precautions. What should the nurse emphasize during this teaching? Remind parents that the child should avoid immunizations to prevent the introduction of bacteria into the body. Treat upper respiratory infections with over-the-counter medication. Ensure a consistent and daily intake of adequate fluids to prevent dehydration. Suggest the child participate in sports activities without restriction.
Ensure a consistent and daily intake of adequate fluids to prevent dehydration. Explanation: Safety interventions for the child with sickle cell anemia include ensuring an adequate daily intake of fluids to prevent dehydration. Dehydration will precipitate a crisis, which can be avoided. The child should avoid contact sports and long-distance running. Upper respiratory infections should be reported to the health care provider so appropriate treatment can be provided. Routine health care such as immunizations should be provided in order to prevent common childhood illnesses.
The nurse is caring for a 13-year-old boy with acute myeloid leukemia (AML) who is experiencing feelings of powerlessness due to the effects of chemotherapy. What intervention will best help the teen's sense of control? Providing realistic expectations of treatments and outcomes Recognizing abilities that are unaffected by the disease Involving the boy in decisions whenever possible Acknowledging the boy's feelings of anger with the disease
Involving the boy in decisions whenever possible Explanation: Involving the boy in the decision-making process will best help his sense of control. Whether he is included in important decisions about therapy or minor decisions like menus or dress, it will give him a sense of control over his situation. Acknowledging feelings of anger, recognizing his abilities, and providing realistic expectations will reduce body image disturbance and build self-esteem.
Nursing students are reviewing information about childhood cancers. They demonstrate understanding of the information when they identify what as the most frequent type? Leukemia Wilms tumor Non-Hodgkin lymphoma Brain stem tumor
Leukemia Explanation: Although Wilms tumor, brain stem tumors, and non-Hodgkin lymphoma can occur in children, the most frequent type of cancer in children is leukemia.
A nurse is caring for a 12-year-old girl who is recovering from surgery for removal of a brain tumor. Which intervention should the nurse implement to avoid increasing intracranial pressure? Regulate the rate of IV fluid infusions carefully Apply saline eye drops, as prescribed Sponge the client's face Place a sterile towel under wet dressings
Regulate the rate of IV fluid infusions carefully Explanation: Be certain to regulate the rate of IV fluid infusions carefully because an increase in the infusion rate has the potential to increase intracranial pressure. The other answers refer to other interventions, unrelated to intracranial pressure.
A child with cancer has developed neutropenia and is in isolation with neutropenic precautions. What nursing assessment takes priority for this child? infection symptoms vital signs bleeding mucositis
infection symptoms Explanation: The neutrophils are the primary means of fighting bacterial infection. When the neutrophil count is very low, the child has the potential to have an overwhelming bacterial infection. The child is at the greatest risk when the neutrophil count is less than 500/mcl (0.50 ×109/l). The nurse's priority would be to assess for signs and symptoms of infection. A bacterial infection can be life-threatening for this child. This child would be placed in neutropenic precautions. This is a form of isolation where the child is protected from health care workers and outside visitors. Among other precautions, no plants would be allowed in the room, raw fruits or vegetables would not be consumed unless washed under running water and lightly scrubbed, and the child should have no rectal examinations or medications and not experience a urinary catheterization. To prevent an infection, the nurse would administer broad spectrum antibiotics. The vital signs should be assessed every 4 hours, and alterations could indicate more problems than just infection. Mucositis occurs when there is an ulcerated oral mucosa. It should be assessed but is not the priority. Bleeding would be more related to low platelet count and not neutrophils.
