PEDS EXAM 5

Which factor predisposes a child to urinary tract infections? a. Increased fluid intake b. Short urethra in young girls c. Prostatic secretions in males d. Frequent emptying of the bladder

ANS: B The short urethra in females provides a ready pathway for invasions of organisms. Increased fluid intake and frequent bladder emptying offer protective measures against urinary tract infections. Prostatic secretions have antibacterial properties that inhibit bacteria.

In which condition are all the formed elements of the blood simultaneously depressed? a. Aplastic anemia b. Sickle cell anemia c. Thalassemia major d. Iron deficiency anemia

ANS: A Aplastic anemia refers to a bone marrowfailure condition in which the formed elements of the blood are simultaneously depressed. Sickle cell anemia is a hemoglobinopathy in which normal adult hemoglobin is partly or completely replaced by abnormal sickle hemoglobin. Thalassemia major is a group of blood disorders characterized by deficiency in the production rate of specific hemoglobin globin chains. Iron deficiency anemia results in a decreased amount of circulating red cells.

The nurse is planning care for an adolescent with acquired immunodeficiency syndrome. The priority nursing goal is to: a. Prevent infection. b. Prevent secondary cancers. c. Restore immunologic defenses. d. Identify source of infection.

ANS: A As a result of the immunocompromise that is associated with human immunodeficiency virus infection, the prevention of infection is paramount. Although certain precautions are justified in limiting exposure to infection, these must be balanced with the concern for the childs normal developmental needs. Restoring immunologic defenses is not currently possible. Current drug therapy is affecting the disease progression; although not a cure, these drugs can suppress viral replication, preventing further deterioration. Case finding is not a priority nursing goal.

Which statement best explains why iron deficiency anemia is common during toddlerhood? A. Milk is a poor source of iron. B. Iron cannot be stored during fetal development. C. Fetal iron stores are depleted by age 1 month. D. Dietary iron cannot be started until age 12 months.

ANS: A Children between the ages of 12 and 36 months are at risk for anemia because cows milk is a major component of their diet, and it is a poor source of iron. Iron is stored during fetal development, but the amount stored depends on maternal iron stores. Fetal iron stores are usually depleted by age 5 to 6 months. Dietary iron can be introduced by breastfeeding, iron-fortified formula, and cereals during the first 12 months of life.

What should the nurse recommend to prevent urinary tract infections in young girls? A. Wearing cotton underpants B. Limiting bathing as much as possible C. Increasing fluids; decreasing salt intake D. Cleansing the perineum with water after voiding

ANS: A Cotton underpants are preferable to nylon underpants. No evidence exists that limiting bathing, increasing fluids, decreasing salt intake, or cleansing the perineum with water decreases urinary tract infections in young girls.

A possible cause of acquired aplastic anemia in children is: a. Drugs. b. Injury. c. Deficient diet. d. Congenital defect.

ANS: A Drugs such as chemotherapeutic agents and several antibiotics such as chloramphenicol can cause aplastic anemia. Fanconi syndrome is a primary form of the disorder, which is congenital/present-at-birth and not acquired after birth. Injury, deficient diet, and congenital defect are not causative agents in acquired aplastic anemia.

What is the most common mode of transmission of human immunodeficiency virus (HIV) in the pediatric population? a. Perinatal transmission b. Sexual abuse c. Blood transfusions d. Poor hand washing

ANS: A Perinatal transmission accounts for the highest percentage (91%) of HIV infections in children. Infected women can transmit the virus to their infants across the placenta during pregnancy, at delivery, and through breastfeeding. Cases of HIV infection from sexual abuse have been reported; however, perinatal transmission accounts for most pediatric HIV infections. In the past some children became infected with HIV through blood transfusions; however, improved laboratory screening has significantly reduced the probability of contracting HIV from blood products. Poor hand washing is not an etiology of HIV infection.

An inherited immunodeficiency disorder characterized by absence of both humoral and cell-mediated immunity is: a. Severe combined immunodeficiency syndrome (SCIDS). b. Acquired immunodeficiency syndrome. c. Wiskott-Aldrich syndrome. d. Fanconi syndrome.

ANS: A Severe SCIDS is a genetic disorder that results in deficits of both humoral and cellular immunity. Acquired immunodeficiency syndrome is not inherited. Wiskott-Aldrich syndrome is an X-linked recessive disorder with selected deficiencies of T and B lymphocytes. Fanconi syndrome is a hereditary disorder of red cell production.

The most appropriate nursing diagnosis for a child with anemia is: a. Activity Intolerance related to generalized weakness. b. Decreased Cardiac Output related to abnormal hemoglobin. c. Risk for Injury related to depressed sensorium. d. Risk for Injury related to dehydration and abnormal hemoglobin.

ANS: A The basic pathology in anemia is the decreased oxygen-carrying capacity of the blood. The nurse must assess the childs activity level (response to the physiologic state). The nursing diagnosis would reflect the activity intolerance. In generalized anemia no abnormal hemoglobin may be present. Only at a level of very severe anemia does cardiac output become altered. No decreased sensorium exists until profound anemia occurs. Dehydration and abnormal hemoglobin are not usually part of anemia.

A young child with leukemia has anorexia and severe stomatitis. The nurse should suggest that the parents try which intervention? a. Relax any eating pressures. b. Firmly insist that child eat normally. c. Begin gavage feedings to supplement diet. d. Serve foods that are either hot or cold.

ANS: A A multifaceted approach is necessary for children with severe stomatitis and anorexia. First, the parents should relax eating pressures rather than insisting the child eat normally. The nurse should suggest that the parents try soft, bland foods rather than hot or cold foods; normal saline or bicarbonate mouthwashes; and local anesthetics. The stomatitis is a temporary condition; gavage feedings are not necessary. The child can resume good food habits as soon as the condition resolves.

The pediatric nurse attends a debriefing session following the death of a young child who was hospitalized for several months with cancer. The nurse developed a strong relationship with the child and even worked overtime to care for the child. The nurse now describes feelings of sadness, insomnia, fatigue, helplessness, and frustration. Which type of suffering is this nurse experiencing? a. Burnout b. Compassion fatigue c. Family empathy d. Moral distress

ANS: A Burnout is a state of physical, emotional, and mental exhaustion caused by long-term involvement in emotionally demanding situations. It emerges gradually and is a result of emotional exhaustion and job stress. The nurse who is experiencing a severe stress reaction like burnout can seek professional help and participate in a support group to replenish or maximize effective coping strategies.

Prior to administering IV chemotherapy, which action by the nurse is most important? a. Ensure the IV has a good blood return. b. Provide diversionary activities. c. Take and record a set of vital signs. d. Weigh the child.

ANS: A To prevent extravasation of IV chemotherapy it is important to make sure the line flushes easily and has a good blood return. This is a critical action to maintain patient safety. The other actions may also be utilized, but would not take priority over ensuring patient safety.

A nurse caring for a child receiving chemotherapy notes that the childs urine specific gravity is 1.010. Which action by the nurse is the most appropriate? a. Document the findings in the childs chart. b. Increase the rate of the IV fluids per protocol. c. Notify the provider about the laboratory results. d. Prepare to administer an alkalizing agent.

ANS: A Children on chemotherapy should remain well hydrated to ensure the medications and any toxic by-products are flushed out. The urine specific gravity should remain at 1.012 or below. The nurse needs to take no further action after documenting the findings. The IV rate should be increased if the specific gravity is above that level. The provider does not need to be notified specifically about this normal finding. An alkalizing agent is not needed.

Therapeutic management of nephrosis includes: a. Corticosteroids. b. Antihypertensive agents. c. Long-term diuretics. d. Increased fluids to promote diuresis.

ANS: A Corticosteroids are the first line of therapy for nephrosis. Response is usually seen within 7 to 21 days. Antihypertensive agents and long-term diuretic therapy are usually not necessary. A diet that has fluid and salt restrictions may be indicated.

An adolescent with osteosarcoma is scheduled for a leg amputation in 2 days. The nurses approach should include which action? a. Answering questions with straightforward honesty b. Avoiding discussing the seriousness of the condition c. Explaining that, although the amputation is difficult, it will cure the cancer d. Assisting the adolescent in accepting the amputation as better than a long course of chemotherapy

ANS: A Honesty is essential to gain the childs cooperation and trust. The diagnosis of cancer should not be disguised with falsehoods. The adolescent should be prepared for the surgery so he or she has time to reflect on the diagnosis and subsequent treatment. This allows questions to be answered. To accept the need for radical surgery, the child must be aware of the lack of alternatives for treatment. Amputation is necessary, but it will not guarantee a cure. Chemotherapy is an integral part of the therapy with surgery. The child should be informed of the need for chemotherapy and its side effects before surgery.

The nurse is administering an intravenous chemotherapeutic agent to a child with leukemia. The child suddenly begins to wheeze and have severe urticaria. Which is the most appropriate nursing action? a. Stop drug infusion immediately. b. Recheck rate of drug infusion. c. Observe child closely for next 10 minutes. d. Explain to child that this is an expected side effect.

ANS: A If an allergic reaction is suspected, the drug should be immediately discontinued. Any drug in the line should be withdrawn, and a normal saline infusion begun to keep the line open. Rechecking the rate of drug infusion, observing the child closely for next 10 minutes, and explaining to the child that this is an expected side effect can all be done after the drug infusion is stopped and the child is evaluated.

A common clinical manifestation of Hodgkins disease is: a. Petechiae. b. Bone and joint pain. c. Painful, enlarged lymph nodes. d. Enlarged, firm, nontender lymph nodes.

ANS: D Asymptomatic, enlarged, cervical or supraclavicular lymphadenopathy is the most common presentation of Hodgkins disease. Petechiae are usually associated with leukemia. Bone and joint pain are not likely in Hodgkins disease. The enlarged nodes are rarely painful.

What is the priority nursing intervention for a child hospitalized with hemarthrosis resulting from hemophilia? a. Immobilization and elevation of the affected joint b. Administration of acetaminophen for pain relief c. Assessment of the childs response to hospitalization d. Assessment of the impact of hospitalization on the family system

ANS: A Immobilization and elevation of the joint will prevent further injury until bleeding is resolved. Although acetaminophen may help with pain associated with the treatment of hemarthrosis, it is not the priority nursing intervention. Assessment of a childs response to hospitalization is relevant to all hospitalized children; however, in this situation, psychosocial concerns are secondary to physiologic concerns. A priority nursing concern for this child is the management of hemarthrosis. Assessing the impact of hospitalization on the family system is relevant to all hospitalized children; however, it is not the priority in this situation.

The nurse closely monitors the temperature of a child with nephrosis. The purpose of this is to detect an early sign of: a. Infection. b. Hypertension. c. Encephalopathy. d. Edema.

ANS: A Infection is a constant source of danger to edematous children and those receiving corticosteroid therapy. An increased temperature could be an indication of an infection, but it is not an indication of hypertension or edema. Encephalopathy is not a complication usually associated with nephrosis. The child will most likely have neurologic signs and symptoms.

A nurse is conducting a staff in-service on childhood cancers. Which is the primary site of osteosarcoma? a. Femur b. Humerus c. Pelvis d. Tibia

ANS: A Osteosarcoma is the most frequently encountered malignant bone cancer in children. The peak incidence is between ages 10 and 25 years. More than half occur in the femur. After the femur, most of the remaining sites are the humerus, tibia, pelvis, jaw, and phalanges.

What should the nurse include in a teaching plan for the parents of a child with vesicoureteral reflux? a. The importance of taking prophylactic antibiotics b. Suggestions for how to maintain fluid restrictions c. The use of bubble baths as an incentive to increase bath time d. The need for the child to hold urine for 6 to 8 hours

ANS: A Prophylactic antibiotics are used to prevent urinary tract infections (UTIs) in a child with vesicoureteral reflux, although this treatment plan has become controversial. Fluids are not restricted when a child has vesicoureteral reflux. In fact, fluid intake should be increased as a measure to prevent UTIs. Bubble baths should be avoided to prevent urethral irritation and possible UTI. To prevent UTIs, the child should be taught to void frequently and never resist the urge to urinate.

The nurse is conducting an assessment on a school-age child with urosepsis. Which assessment finding should the nurse expect? a. Fever with a positive blood culture b. Proteinuria and edema c. Oliguria and hypertension d. Anemia and thrombocytopenia

ANS: A Symptoms of urosepsis include a febrile urinary tract infection coexisting with systemic signs of bacterial illness; blood culture reveals the presence of a urinary pathogen. Proteinuria and edema are symptoms of minimal change nephrotic syndrome. Oliguria and hypertension are symptoms of acute glomerulonephritis. Anemia and thrombocytopenia are symptoms of hemolytic uremic syndrome.

The primary clinical manifestations of acute renal failure are: a. Oliguria and hypertension. b. Hematuria and pallor. c. Proteinuria and muscle cramps. d. Bacteriuria and facial edema.

ANS: A The principal feature of acute renal failure is oliguria. Hematuria and pallor, proteinuria and muscle cramps, and bacteriuria and facial edema are not principal features of acute renal failure.

Which diagnostic test allows visualization of the renal parenchyma and renal pelvis without exposure to external beam radiation or radioactive isotopes? a. Renal ultrasound b. Computed tomography c. Intravenous pyelography d. Voiding cystourethrography

ANS: A The transmission of ultrasonic waves through the renal parenchyma allows visualization of the renal parenchyma and renal pelvis without exposure to external beam radiation or radioactive isotopes. Computed tomography uses external radiation, and sometimes contrast media are used. Intravenous pyelography uses contrast medium and external radiation for x-ray films. Contrast medium is injected into the bladder through the urethral opening for voiding cystourethrography. External radiation for x-ray films is used before, during, and after voiding.

A 4-year-old child is several days postoperative after a resection of a brain tumor. The nurse finds the child irritable and lethargic, and notes that she has vomited. Which medication does the nurse anticipate administering? a. Dexamethasone (Decadron) b. Fosphenytoin (Cerebyx) c. Odansetron (Zofran) d. Phenytoin (Dilantin)

ANS: A This child has manifestations of increased intracranial pressure, a possible outcome after brain surgery. The nurse prepares to administer a corticosteroid to decrease the edema. Fosphenytoin and phenytoin are for seizures. Odansetron is for nausea.

A child has the following laboratory values: WBC, 7.2 mm3; bands, 4%; and neutrophils, 60%. Based on these values, which action by the nurse is the most appropriate? a. Continue monitoring the child for infection. b. Place the child on protective isolation. c. Obtain two sets of blood cultures. d. Restrict visitors to the child.

ANS: A This childs absolute neutrophil count is 4,608; therefore, the child is not neutropenic. The nurse should continue to monitor. The other actions are not necessary.

A parent confides to the nurse that a friend, who is 32, has been diagnosed with Hodgkins disease. The parent says I thought only children get that! What response by the nurse is the most appropriate? a. No, there are both young adult and older adult forms. b. Usually people over the age of 50 do not get this. c. Yes, only children under the age of 10 are affected. d. You are right; your friend must have misspoken.

ANS: A Three groups are affected by Hodgkins disease: children younger than 14, young adults 1534 years of age, and older adults 5574 years of age. The parents friend could certainly be correct about the diagnosis.

The school nurse is informed that a child with human immunodeficiency virus (HIV) will be attending school soon. Which is an important nursing intervention? a. Carefully follow universal precautions. b. Determine how the child became infected. c. Inform the parents of the other children. d. Reassure other children that they will not become infected.

ANS: A Universal precautions are necessary to prevent further transmission of the disease. It is not the role of the nurse to determine how the child became infected. Informing the parents of other children and reassuring other children that they will not become infected is a violation of the childs right to privacy.

When a child has chronic renal failure, the progressive deterioration produces a variety of clinical and biochemical disturbances that eventually are manifested in the clinical syndrome known as: a. Uremia. b. Oliguria. c. Proteinuria. d. Pyelonephritis.

ANS: A Uremia is the retention of nitrogenous products, producing toxic symptoms. Oliguria is diminished urine output. Proteinuria is the presence of protein, usually albumin, in the urine. Pyelonephritis is an inflammation of the kidney and renal pelvis.

A cure is no longer possible for a young child with cancer. The nursing staff recognizes that the goal of treatment must shift from cure to palliation. Which is an important consideration at this time? a. The family is included in the decision to shift the goals of treatment. b. The decision must be made by the health professionals involved in the childs care. c. The family needs to understand that palliative care takes place in the home. d. The decision should not be communicated to the family because it will encourage a sense of hopelessness.

ANS: A When the child reaches the terminal stage, the nurse and physician should explore the familys wishes. The family should help decide what interventions will occur as they plan for their childs death.

A child is being admitted with an infratentorial brain tumor. Which anatomical regions of the brain does the nurse know this tumor might include? (Select all that apply.) a. Brainstem b. Cerebellum c. Cerebrum d. Frontal lobe e. Parietal lobe

ANS: A, B Brain tumors in children are classified as either supratentorial or infratentorial. Infratentorial tumors are located in the posterior third of the brain, below the tentorium, and involve the brainstem and cerebellum. The cerebrum, frontal, and parietal lobes are located in the supratentorial section of the brain, which is the anterior two-thirds of the brain structure.

A student is learning about the process of hematopoiesis and how it is affected by leukemia. Which information does the student discover? (Select all that apply.) a. Blast cells multiply faster than mature cells. b. Leukemia disrupts normal hematopoiesis. c. Lymphoid cells differentiate into B and T cells. d. Myeloid cells crowd out normal cells in bone marrow. e. Pancytopenia occurs from proliferation of mast cells.

ANS: A, B, C Blast, or immature, cells have an increased rate of proliferation and multiply at the expense of normal cells. Leukemia does disrupt normal hematopoiesis (production and development of blood cells). Lymphoid cells differentiate into B and T cells. Myeloid cells differentiate into red blood cells, monocytes, granulocytes, and platelets; they do not reproduce and crowd out normal cells in the marrow. Pancytopenia occurs when large numbers of blast cells reproduce and crowd out normal marrow components.

A nurse is reviewing a patients chart and notes that the patient has a cancerous tumor that has invaded other organs. Based on this information, at which stage is this patients cancer classified? a. Stage O b. Stage I c. Stage III d. Stage IV

ANS: D A stage IV cancer is one that has invaded other organs. Stage 0 is early cancer, present only in the cells in which it began. Stages I-III are more extensive, with larger tumors and spread to nearby lymph nodes or adjacent organs.

The nurse is teaching a community group about early warning signs of cancer. Which signs does the nurse include? (Select all that apply.) a. A sore that does not heal b. Change in bowel or bladder habits c. Difficulty swallowing or indigestion d. Nagging feeling that something is wrong e. Unusual bleeding or discharge

ANS: A, B, C, E The American Cancer Society uses the acronym CAUTION to describe common warning signs of cancer: change in bowel or bladder habits; a sore that does not heal; unusual bleeding or discharge; thickening or lump in the breast, testicles, or elsewhere; indigestion or trouble swallowing; obvious change in the size, color shape, or thickness of a wart, mole, or mouth sore; and nagging cough or hoarseness.

The staff nurse is educating nursing students on the long-term effects of childhood chemotherapy. Which problems does the nurse include in the educational session? (Select all that apply.) a. Cardiac dysfunction b. Hearing loss c. Increased risk of multiple-gestation pregnancies d. Learning disabilities e. Peripheral neuropathy

ANS: A, B, D, E The list of long-term effects of chemotherapy is lengthy and includes cardiac dysfunction, hearing loss, learning disabilities, and peripheral neuropathy, among others. Sterility, not an increased risk for multiple- gestation pregnancies, is also an effect.

The student nurse studying childhood cancers understands that neoplasms are caused by which factors? (Select all that apply.) a. Chromosomal/genetic abnormalities b. External stimuli or environment c. Maternal nutrition during gestation d. Substance abuse during pregnancy e. Viruses that alter the immune system

ANS: A, B, E Neoplasms are caused by one or a combination of the following: chromosomal or genetic abnormalities, external stimuli or the environment, and/or viruses that alter the immune system. Nutritional deficits and substance abuse by the mother can certainly lead to developmental and other health problems, but do not lead to childhood cancers.

A child is getting induction therapy for Burkitt lymphoma. The nurse finds the child lethargic and complaining of side and back pain. The childs morning laboratory results indicate a serum calcium level of 7.2 mg/dL. What actions by the nurse are the most appropriate at this time? (Select all that apply.) a. Administer a dose of pain medication. b. Assess Chvostek and Trousseau signs. c. Call the rapid response team. d. Encourage an increased oral intake. e. Prepare to administer allopurinol (Aloprim).

ANS: A, B, E This child is manifesting signs of tumor lysis syndrome. The child is at risk due to the rapid destruction of cancer cells (induction therapy) and from the childs type of cancer (Burkitt lymphoma). Lethargy, flank pain, and hypocalcemia are common findings in this condition. The nurse should administer pain medication, assess for physical manifestations of hypocalcemia (Chvostek and Trousseau signs), and prepare to administer allopurinol. Adequate hydration is important as well, but because the child is lethargic, IV fluids should be given, not oral fluids. The rapid response team is not needed at this point.

The nurse is teaching parents about the importance of good nutrition for their child who has cancer. Which components does the nurse include as important for this childs diet? (Select all that apply.) a. High calories b. High carbohydrates c. High vitamins d. Low minerals e. Low protein

ANS: A, C The child with cancer needs optimal nutrition, including a diet high in calories, fatty acids, vitamins, protein, and minerals.

The nurse is explaining types of solid tumors to a group of students. Which information does the nurse include? (Select all that apply.) a. A sarcoma is found in bone or muscle. b. Carcinoma means any cancerous tumor. c. Epithelial cells give rise to carcinomas. d. Lymphoma might originate in the thymus. e. Pediatric and adult solid tumors are similar.

ANS: A, C, D Pediatric and adult solid tumors are very different. A sarcoma arises from connective or supporting tissues, such as bones or muscle. A carcinoma is cancer arising from glandular and/or epithelial cells. Lymphomas originate in lymphoid organs, such as the lymph nodes, spleen, and thymus.

The nurse is preparing to give oral care to a school-age child with mucositis secondary to chemotherapy administered to treat leukemia. Which preparations should the nurse use for oral care on this child (Select all that apply)? a. Chlorhexidine gluconate (Peridex) b. Lemon glycerin swabs c. Antifungal troches (lozenges) d. Lip balm (Aquaphor) e. Hydrogen peroxide

ANS: A, C, D Preparations that may be used to prevent or treat mucositis include chlorhexidine gluconate (Peridex) because of its dual effectiveness against candidal and bacterial infections, antifungal troches (lozenges) or mouthwash, and lip balm (e.g., Aquaphor) to keep the lips moist. Agents that should not be used include lemon glycerin swabs (irritate eroded tissue and can decay teeth), hydrogen peroxide (delays healing by breaking down protein), and milk of magnesia (dries mucosa).

Which home care instructions should the nurse provide to the parents of a child with acquired immunodeficiency syndrome (AIDS) (Select all that apply)? a. Give supplemental vitamins as prescribed. b. Yearly influenza vaccination should be avoided. c. Administer trimethoprim-sulfamethoxazole (Bactrim) as prescribed. d. Notify the physician if the child develops a cough or congestion. e. Missed doses of antiretroviral medication do not need to be recorded.

ANS: A, C, D The parents should be taught that supplemental vitamins will be prescribed to aid in nutritional status. Bactrim is administered to prevent the opportunistic infection of Pneumocystis jiroveci pneumonia. The physician should be notified if the child with AIDS develops a cough and congestion. The yearly influenza vaccination is recommended, and any missed doses of antiretroviral medication need to be recorded and reported.

A child has been admitted with a paraspinal Ewings sarcoma. The nursing instructor questions the student about assessing for signs of spinal cord compression. Which manifestations does this include? (Select all that apply.) a. Burning pain down the legs b. Difficulty with swallowing c. Foot drop, causing a limp d. Respiratory depression e. Weakness in the hands

ANS: A, C, E Common manifestations of spinal cord compression include burning pain, often down the legs; foot drop causing difficulty with ambulation; and weakness in the hands. Other manifestations include numbness, cramping, and loss of sensation in the feet, and sexual dysfunction in the older patient. Swallowing problems and respiratory depression are not related.

A nurse is explaining radiation side effects to the parents of a child for whom it has been ordered. Which side effects does the nurse include in the explanation? (Select all that apply.) a. Hair loss b. Leukocytosis c. Nausea d. Polycythemia e. Skin desquamation

ANS: A, C, E Common side effects of radiation include nausea, alopecia (hair loss), fatigue and malaise, low WBC, skin desquamation, and mucous membrane inflammation and irritation. Leukocytosis (high WBC count) and polycythemia (increased RBC count) are not seen.

A student nurse is preparing to administer odansetron (Zofran) to a child receiving chemotherapy. The child weighs 44 lb (20 kg). Which actions by the student nurse require intervention by the faculty? (Select all that apply.) a. Assesses the childs pain with a pediatric scale b. Discusses side effects with the parents/child c. Draws up 300 mg for IV administration d. Prepares to administer 3 mg IV push e. Withdraws a 200-mg suppository for use

ANS: A, C, E Odansetron is an anti-emetic (not a pain medication) and can be given IV at 0.15 mg/kg, making the correct dose 3 mg. The faculty member should intervene if the student assesses pain, not nausea; draws up 300 mg; or tries to obtain a suppository for the child. Odansetron can also be given PO. Discussing side effects is a responsibility when giving medications.

The nurse is caring for an infant with a suspected urinary tract infection. Which clinical manifestations would be observed (Select all that apply)? a. Vomiting b. Jaundice c. Failure to gain weight d. Swelling of the face e. Back pain f. Persistent diaper rash

ANS: A, C, F Vomiting, failure to gain weight, and persistent diaper rash are clinical manifestations observed in an infant with a urinary tract infection. Jaundice, swelling of the face, and back pain would not be observed in an infant with a urinary tract infection.

The nurse working with pediatric oncology patients educates the patients and families regarding best long- term follow-up practices. Which recommendations does this include? (Select all that apply.) a. Continued care by an interdisciplinary team b. Height measurements until puberty is reached c. Genetic testing prior to having children d. Risk-based follow-up appointments e. Thyroid screening for 5 years after remission

ANS: A, D Best-practice recommendations for follow-up include risk-based referrals and continued involvement of an interdisciplinary team of specialists. Height measurements are important for children until their adult height is achieved. Genetic testing is only recommended for certain types of cancer. Thyroid screening is important throughout the lifetime of survivors who were treated with radiotherapy to the neck, spine, or brain.

A school-age child is admitted to the hospital with acute glomerulonephritis and oliguria. Which dietary menu items should be allowed for this child (Select all that apply)? a. Apples b. Bananas c. Cheese d. Carrot sticks e. Strawberries

ANS: A, D, E Moderate sodium restriction and even fluid restriction may be instituted for children with acute glomerulonephritis. Foods with substantial amounts of potassium and sodium are generally restricted during the period of oliguria. Apples, carrot sticks, and strawberries would be items low in sodium and allowed. Bananas are high in potassium and cheese is high in sodium. Those items would be restricted.

A young boy will receive a bone marrow transplant (BMT). This is possible because one of his older siblings is a histocompatible donor. This type of BMT is termed: a. Syngeneic. b. Allogeneic. c. Monoclonal. d. Autologous.

ANS: B Allogeneic transplants are from another individual. Because he and his sibling are histocompatible, the bone marrow transplantation can be done. Syngeneic marrow is from an identical twin. There is no such thing as a monoclonal bone marrow transplant. Autologous refers to the individuals own marrow.

A school-age child with chronic renal failure is admitted to the hospital with a serum potassium level of 5.2 mEq/L. Which prescribed medication should the nurse plan to administer? a. Spironolactone (Aldactone) b. Sodium polystyrene sulfonate (Kayexalate) c. Lactulose (Cephulac) d. Calcium carbonate (Calcitab)

ANS: B Normal serum potassium levels in a school-age child are 3.5 to 5 mEq/L. Sodium polystyrene sulfonate is administered to reduce serum potassium levels. Spironolactone is a potassium-sparing diuretic and should not be used if the serum potassium is elevated. Lactulose is administered to reduce ammonia levels in patients with liver disease. Calcium carbonate may be prescribed as a calcium supplement, but it will not reduce serum potassium levels.

The narrowing of preputial opening of foreskin is called: a. Chordee b. Phimosis c. Epispadias d. Hypospadias

ANS: B Phimosis is the narrowing or stenosis of the preputial opening of the foreskin. Chordee is the ventral curvature of the penis. Epispadias is the meatal opening on the dorsal surface of the penis. Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis.

A condition in which the normal adult hemoglobin is partly or completely replaced by abnormal hemoglobin is: a. Aplastic anemia. b. Sickle cell anemia. c. Thalassemia major. d. Iron deficiency anemia.

ANS: B Sickle cell anemia is one of a group of diseases collectively called hemoglobinopathies, in which normal adult hemoglobin is replaced by abnormal hemoglobin. Aplastic anemia is a lack of cellular elements being produced. Hemophilia refers to a group of bleeding disorders in which there is deficiency of one of the factors necessary for coagulation. Iron deficiency anemia affects size and depth of color of hemoglobin and does not involve abnormal hemoglobin.

Which immunization should be given with caution to children infected with human immunodeficiency virus? a. Influenza b. Varicella c. Pneumococcus d. Inactivated poliovirus

ANS: B The children should be carefully evaluated before giving live viral vaccines such as varicella, measles, mumps, and rubella. The child must be immunocompetent and not have contact with other severely immunocompromised individuals. Influenza, pneumococcus, and inactivated poliovirus are not live vaccines.

The nurse is conducting teaching for an adolescent being discharged to home after a renal transplantation. The adolescent needs further teaching if which statement is made? a. I will report any fever to my primary health care provider. b. I am glad I only have to take the immunosuppressant medication for two weeks. c. I will observe my incision for any redness or swelling. d. I wont miss doing kidney dialysis every week.

ANS: B The immunosuppressant medications are taken indefinitely after a renal transplantation, so they should not be discontinued after 2 weeks. Reporting a fever and observing an incision for redness and swelling are accurate statements. The adolescent is correct in indicating dialysis will not need to be done after the transplantation.

A boy with leukemia screams whenever he needs to be turned or moved. The most probable cause of this pain is: a. Edema. b. Bone involvement. c. Petechial hemorrhages. d. Changes within the muscles.

ANS: B The invasion of the bone marrow with leukemic cells gradually causes a weakening of the bone and a tendency toward fractures. As leukemic cells invade the periosteum, increasing pressure causes severe pain. Edema, petechial hemorrhages, and muscular changes would not cause severe pain.

A school-age child is admitted in vaso-occlusive sickle cell crisis. The childs care should include: a. Correction of acidosis. b. Adequate hydration and pain management. c. Pain management and administration of heparin. d. Adequate oxygenation and replacement of factor VIII.

ANS: B The management of crises includes adequate hydration, minimizing energy expenditures, pain management, electrolyte replacement, and blood component therapy if indicated. The acidosis will be corrected as the crisis is treated. Heparin and factor VIII are not indicated in the treatment of vaso-occlusive sickle cell crisis. Oxygen may prevent further sickling, but it is not effective in reversing sickling because it cannot reach the clogged blood vessels.

An objective of care for the child with nephrosis is to: A. Reduce blood pressure. B. Reduce excretion of urinary protein. C. Increase excretion of urinary protein. D. Increase ability of tissues to retain fluid.

ANS: B The objectives of therapy for the child with nephrosis include reduction of the excretion of urinary protein, reduction of fluid retention, prevention of infection, and minimizing of complications associated with therapy. Blood pressure is usually not elevated in nephrosis. Increased excretion of urinary protein and increased ability of tissues to retain fluid are part of the disease process and must be reversed.

The parents of a child hospitalized with sickle cell anemia tell the nurse that they are concerned about narcotic analgesics causing addiction. The nurse should explain that narcotic analgesics: a. Are often ordered but not usually needed. b. Rarely cause addiction because they are medically indicated. c. Are given as a last resort because of the threat of addiction. d. Are used only if other measures such as ice packs are ineffective.

ANS: B The pain of sickle cell anemia is best treated by a multidisciplinary approach. Mild-to-moderate pain can be controlled by ibuprofen and acetaminophen. When narcotics are indicated, they are titrated to effect and given around the clock. Patient-controlled analgesia reinforces the patients role and responsibility in managing the pain and provides flexibility in dealing with pain. Few if any patients who receive opioids for severe pain become behaviorally addicted to the drug. Narcotics are often used because of the severe nature of the pain of vaso-occlusive crisis. Ice is contraindicated because of its vasoconstrictive effects.

The nurse is completing an admission assessment on a 3-year-old child. The childs Humpty Dumpty score is 15. Which action by the nurse is the most appropriate? a. Allow the child access to the play room. b. Classify the child as at high risk for falls. c. Place the child on seizure precautions. d. Put the child in isolation precautions.

ANS: B A Humpty Dumpty score of 12 or above indicates a high risk for falls. The child has been classified as at high risk for falls, and nursing care should be implemented to prevent them. Access to the play room can be accomplished with almost any child. Seizures and isolation actions are not related.

A nurse is preparing to administer chemotherapy to a child who has an Infuse-a-Port. Which action by the nurse is the most appropriate? a. Flush the catheter with normal saline and heparin. b. Obtain a Huber needle prior to administration. c. Unclamp the catheter prior to flushing the line. d. Wrap the catheter in gauze so it doesnt pull out.

ANS: B A centrally implanted port, such as an Infuse-a-Port, must be accessed with a Huber needle. Prior to administering medication is not the time to flush with heparin. The port is entirely indwelling, so there is no catheter to unclamp, nor will the device pull out.

Chelation therapy is begun on a child with b-thalassemia major. The purpose of this therapy is to: a. Treat the disease. b. Eliminate excess iron. c. Decrease the risk of hypoxia. d. Manage nausea and vomiting.

ANS: B A complication of the frequent blood transfusions in thalassemia is iron overload. Chelation therapy with deferoxamine (an iron-chelating agent) is given with oral supplements of vitamin C to increase iron excretion. Chelation therapy treats the side effects of disease management. Decreasing the risk of hypoxia and managing nausea and vomiting are not the purposes of chelation therapy.

A child is being discharged after surgical resection of a retinoblastoma with enucleation. Which discharge instruction is most important based on the diagnosis? a. Encouraging healthy eating b. Irrigation of the surgical site c. Monitoring the childs temperature d. Pain assessment and control

ANS: B After enucleation (removal of the eye), the eye socket must be irrigated and a thin layer of antibiotic ointment applied. The other options are valid for all postoperative pediatric patients.

A child has liver cancer. The most recent results for the alpha-fetoprotein level show it has been reduced by 50%. Which statement by the nurse to the parents and child is most appropriate at this time? a. Once the level gets to normal, we can resect the tumor. b. This shows the cancer is responding to therapy. c. Unfortunately, the chemotherapy is not working. d. Your child will need a liver transplant soon.

ANS: B Alpha-fetoprotein (AFP) is a protein produced by both hepatoblastomas and hepatocellular carcinomas. Falling levels of AFP indicate that treatment is working. The other responses are not correct.

A young child with human immunodeficiency virus is receiving several antiretroviral drugs. The purpose of these drugs is to: a. Cure the disease. b. Delay disease progression. c. Prevent spread of disease. d. Treat Pneumocystis jiroveci pneumonia.

ANS: B Although not a cure, these antiviral drugs can suppress viral replication, preventing further deterioration of the immune system, and delay disease progression. At this time cure is not possible. These drugs do not prevent the spread of the disease. Pneumocystis jiroveci prophylaxis is accomplished with antibiotics.

A child is admitted and is scheduled to receive intravenous asparginase (Elspar). Which action by the nurse is most important when administering this medication? a. Arranging an outpatient hearing test b. Having emergency drugs on hand c. Monitoring the childs intake and output d. Providing anti-emetic drugs as needed

ANS: B Anaphylaxis is a possible side effect of this drug. Emergency medications should be readily available. Ototoxicity can be caused by carboplatin (Paraplatin). Monitoring intake and output is important for any child on IV therapy. Anti-emetic drugs are important for any child receiving chemotherapy.

A nurse is caring for a child who is scheduled to have intrathecal chemotherapy today. Which action by the nurse is most important when providing care to this patient and family? a. Educating family on side effects of chemotherapy b. Ensuring a signed consent is on the chart c. Providing distraction techniques during the process d. Reassuring the child the parents will be present

ANS: B Intrathecal chemotherapy (introducing chemotherapy into the subarachnoid space of the spinal cord) is an invasive procedure and requires a signed consent. Although all actions are important for this child, the priority is ensuring the consent is executed appropriately and on the chart.

Calcium carbonate is given with meals to a child with chronic renal disease. The purpose of this is to: a. Prevent vomiting. b. Bind phosphorus. c. Stimulate appetite. d. Increase absorption of fat-soluble vitamins.

ANS: B Oral calcium carbonate preparations combine with phosphorus to decrease gastrointestinal absorption and the serum levels of phosphate; serum calcium levels are increased by the calcium carbonate, and vitamin D administration is necessary to increase calcium absorption. Calcium carbonate does not prevent vomiting, stimulate appetite, or increase the absorption of fat-soluble vitamins.

A child has been cured of a retinoblastoma. When the parents ask how long monitoring for bone-related complications of radiation therapy should continue, which is the most appropriate response by the nurse? a. After 5 years, you can stop worrying about this. b. Cancers of the bone can occur up to 15 years later. c. Probably all complications will occur within 3 years. d. Radiation complications do not occur in bones.

ANS: B Osteosarcoma can occur as a consequence of radiation therapy up to 15 years later.

A nurse works on a pediatric oncology unit. After receiving report, which child should the nurse assess first? a. Having infusion of D5 NS and sodium bicarbonate b. On high-dose methotrexate (Rheumatrex), urine pH of 7.8 c. Receiving cyclophosphamide (Cytoxan), urine specific gravity of 1.008 d. 2 days posttumor resection, complaining of pain

ANS: B Patients on high-dose methotrexate need their urine pH to be higher than 7.0. This child needs the nurses attention first. An IV with NaHCO3 is common prior to receiving methotrexate. A urine specific gravity of 1.010 is required for children on chemotherapy. Pain would be an expected finding 2 days postoperatively, and should be treated, but not before the nurse assesses the other child.

The narrowing of the preputial opening of the foreskin is called: a. Chordee. b. Phimosis. c. Epispadias. d. Hypospadias.

ANS: B Phimosis is the narrowing or stenosis of the preputial opening of the foreskin. Chordee is the ventral curvature of the penis. Epispadias is the meatal opening on the dorsal surface of the penis. Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis.

A toddler with leukemia is on intravenous chemotherapy treatments. The toddlers lab results are white blood cell count (WBC): 1000; neutrophils: 7%; nonsegmented neutrophils (bands): 7%. What is this childs absolute neutrophil count (ANC)? _____ Record your answer as a whole number.

Ans: 140

Which statement is descriptive of renal transplantation in children? a. It is an acceptable means of treatment after age 10 years. b. It is preferred means of renal replacement therapy in children. c. Children can receive kidneys only from other children. d. The decision for transplantation is difficult since a relatively normal lifestyle is not possible.

ANS: B Renal transplantation offers the opportunity for a relatively normal lifestyle versus dependence on dialysis and is the preferred means of renal replacement therapy in end-stage renal disease. It can be done in children as young as age 6 months. Both children and adults can serve as donors for renal transplant purposes.

The diet of a child with nephrosis usually includes: a. High protein. b. Salt restriction. c. Low fat. d. High carbohydrate.

ANS: B Salt is usually restricted (but not eliminated) during the edema phase. The child has very little appetite during the acute phase. Favorite foods are provided (with the exception of high-salt ones) in an attempt to provide nutritionally complete meals.

A neutropenic child is admitted to the hospital and placed in protective isolation. Which instruction does the nurse give the family to help maintain a safe environment for the child? a. Do not let the child have chewing gum b. Flowers, plants, and produce are not allowed c. The child can only have one visitor at a time d. Toys and items from home cannot be brought in

ANS: B The neutropenic child should not have fresh flowers, plants, fruits, or vegetables because they can harbor infectious microorganisms. The other instructions are not needed.

A nurse assesses a toddler using the FLACC score. The child is kicking and crying steadily. The mother is upset, as she is unable to console the child. Which action by the nurse is most appropriate? a. Administer acetaminophen (Tylenol). b. Give a dose of morphine (Duramorph). c. Play soothing, quiet music. d. Prepare a dose of propofol (Diprovan).

ANS: B This child exhibits several behaviors seen in the severe pain category according to the FLACC score. The best medication for this level of pain is an opioid analgesic, such as morphine. Tylenol is used for mild to moderate pain. Nonpharmacological measures can be used as an adjunct, but it will not relieve this degree of pain alone. Propofol is usually used for procedures.

A parent brings a child to the clinic and reports that the child is reluctant to walk and has a new limp. The parent also reports that the child seems lethargic and tired all the time. The nurse notes that the child appears pale. Which other finding would warrant immediate notification of the health-care provider? a. Difficulty staying asleep at night b. Left-sided abdominal enlargement c. Polyphagia and polydipsia d. Swelling of the legs and feet

ANS: B This child has some manifestations of acute lymphocytic leukemia (ALL). Left-sided abdominal enlargement could be indicative of splenomegaly, which is another manifestation of this disease. The nurse should report these findings immediately. Difficulty staying asleep at night is vague and could be related to a number of causes, both physical and behavioral. Polydipsia and polyphagia are two of the three classic signs of diabetes. Swelling of the legs and feet is not a manifestation of ALL.

One of the clinical manifestations of chronic renal failure is uremic frost. What best describes this term? a. Deposits of urea crystals in urine b. Deposits of urea crystals on skin c. Overexcretion of blood urea nitrogen d. Inability of body to tolerate cold temperatures

ANS: B Uremic frost is the deposition of urea crystals on the skin, not in the urine. The kidneys are unable to excrete blood urea nitrogen, leading to elevated levels. There is no relation between cold temperatures and uremic frost.

A child is admitted with acute glomerulonephritis. The nurse would expect the urinalysis during this acute phase to show: a. Bacteriuria and hematuria. b. Hematuria and proteinuria. c. Bacteriuria and increased specific gravity. d. Proteinuria and decreased specific gravity.

ANS: B Urinalysis during the acute phase characteristically shows hematuria and proteinuria. Bacteriuria and changes in specific gravity are not usually present during the acute phase.

The nurse is planning care for a school-age child admitted to the hospital with hemophilia. Which interventions should the nurse plan to implement for this child (Select all that apply)? a. Fingersticks for blood work instead of venipunctures b. Avoidance of intramuscular (IM) injections c. Acetaminophen (Tylenol) for mild pain control d. Soft toothbrush for dental hygiene e. Administration of packed red blood cells

ANS: B, C, D Nurses should take special precautions when caring for a child with hemophilia to prevent the use of procedures that may cause bleeding, such as IM injections. The subcutaneous route is substituted for IM injections whenever possible. Venipunctures for blood samples are usually preferred for these children. There is usually less bleeding after the venipuncture than after finger or heel punctures. Neither aspirin nor any aspirin-containing compound should be used. Acetaminophen is a suitable aspirin substitute, especially for controlling mild pain. A soft toothbrush is recommended for dental hygiene to prevent bleeding from the gums. Packed red blood cells are not administered. The primary therapy for hemophilia is replacement of the missing clotting factor. The products available are factor VIII concentrates.

The nurse is caring for a child with aplastic anemia. Which nursing diagnoses are appropriate (Select all that apply)? a. Acute Pain related to vaso-occlusion b. Risk for Infection related to inadequate secondary defenses or immunosuppression c. Ineffective Protection related to thrombocytopenia d. Ineffective Tissue Perfusion related to anemia e. Ineffective Protection related to abnormal clotting

ANS: B, C, D These are appropriate nursing diagnosis for the nurse planning care for a child with aplastic anemia. Aplastic anemia is a condition in which the bone marrow ceases production of the cells it normally manufactures, resulting in pancytopenia. The child will have varying degrees of the disease depending on how low the values are for absolute neutrophil count (affecting the bodys response to infection), platelet count (putting the child at risk for bleeding), and absolute reticulocyte count (causing the child to have anemia). Acute Pain related to vaso-occlusion is an appropriate nursing diagnosis for sickle cell anemia for the child in vaso-occlusive crisis, but it is not applicable to a child with aplastic anemia. Ineffective Protection related to abnormal clotting is an appropriate diagnosis for a child with hemophilia.

A nurse has a RN preceptor student working on the pediatric oncology unit. When teaching the student about oncological crises, what disorders does the nurse include? (Select all that apply.) a. Inferior vena cava infarction b. Neurogenic shock c. Perirectal abscess d. Pleural effusion e. Superior vena cava syndrome

ANS: B, C, D, E There are many oncologic emergencies, including neurogenic shock (and other types of shock), perirectal abscess, pleural effusion, and superior vena cava syndrome. Inferior vena cava infarction is not on the list of emergent conditions.

Which should the nurse teach about prevention of sickle cell crises to parents of a preschool child with sickle cell disease (Select all that apply)? a. Limit fluids at bedtime. b. Notify the health care provider if a fever of 38.5 C (101.3 F) or greater occurs. c. Give penicillin as prescribed. d. Use ice packs to decrease the discomfort of vaso-occlusive pain in the legs. e. Notify the health care provider if your child begins to develop symptoms of a cold.

ANS: B, C, E The most important issues to teach the family of a child with sickle cell anemia are to (1) seek early intervention for problems, such as a fever of 38.5 C (101.3 F) or greater; (2) give penicillin as ordered; (3) recognize signs and symptoms of splenic sequestration, as well as respiratory problems that can lead to hypoxia; and (4) treat the child normally. The nurse emphasizes the importance of adequate hydration to prevent sickling and to delay the adhesionstasisthrombosisischemia cycle. It is not sufficient to advise parents to force fluids or encourage drinking. They need specific instructions on how many daily glasses or bottles of fluid are required. Many foods are also a source of fluid, particularly soups, flavored ice pops, ice cream, sherbet, gelatin, and puddings. Increased fluids combined with impaired kidney function result in the problem of enuresis. Parents who are unaware of this fact frequently use the usual measures to discourage bedwetting, such as limiting fluids at night. Enuresis is treated as a complication of the disease, such as joint pain or some other symptom, to alleviate parental pressure on the child. Ice should not be used during a vaso-occlusive pain crisis because it vasoconstricts and impairs circulation even more.

A pediatric patient is receiving asparaginase (Elspar). What manifestations would lead the nurse to determine that the child is having a possible side effect from this drug? (Select all that apply.) a. Blistering at infusion site b. Increased PT and INR c. Potassium of 2.7 mEq/L d. Seizures e. Shortness of breath

ANS: B, D Some common side effects of Elspar include seizures, hyperglycemia, nausea/vomiting, rashes, coagulation abnormalities, hepatotoxicity, pancreatitis, and anaphylaxis. Blistering is common with daunorubicin (Daunomycin). Hypokalemia is seen with carboplatin (Paraplatin). Shortness of breath could be seen with bleomycin (Blenoxane), which causes pulmonary fibrosis and pneumonitis.

A nurse is caring for several patients with acute lymphocytic leukemia (ALL). Which children does the nurse understand have the best prognosis? a. Infant b. < 10 years of age c. > 25% abnormal cells in bone marrow aspirate d. White count 4,200/mm3 e. White count 25,000/mm3

ANS: B, D The best prognosis for ALL occurs in children 2 to 9 years of age and in children whose initial white blood cell count is < 5,000/mm3. Children 10 and older and whose initial white blood cell counts are ?= 50,000/mm3 have worse prognoses. Infants have a very poor prognosis.

A school-age child has been admitted to the hospital with an exacerbation of nephrotic syndrome. Which clinical manifestations should the nurse expect to assess (Select all that apply)? a. Weight loss b. Facial edema c. Cloudy, smoky browncolored urine d. Fatigue e. Frothy-appearing urine

ANS: B, D, E A child with nephrotic syndrome will present with facial edema, fatigue, and frothy-appearing urine (proteinuria). Weight gain, not loss, is expected because of the fluid retention. Cloudy, smoky browncolored urine is seen with acute glomerulonephritis but not with nephrotic syndrome because there is no gross hematuria associated with nephrotic syndrome.

Parents of a school-age child with hemophilia ask the nurse, Which sports are recommended for children with hemophilia? Which sports should the nurse recommend (Select all that apply)? a. Soccer b. Swimming c. Basketball d. Golf e. Bowling

ANS: B, D, E Because almost all persons with hemophilia are boys, the physical limitations in regard to active sports may be a difficult adjustment, and activity restrictions must be tempered with sensitivity to the childs emotional and physical needs. Use of protective equipment, such as padding and helmets, is particularly important, and noncontact sports, especially swimming, walking, jogging, tennis, golf, fishing, and bowling, are encouraged. Contact sports such as soccer and basketball are not recommended.

Which condition is caused by a virus that primarily infects a specific subset of T lymphocytes, the CD4+ T- cells? a. Wiskott-Aldrich syndrome b. Idiopathic thrombocytopenic purpura (ITP) c. Acquired immunodeficiency syndrome (AIDS) d. Severe combined immunodeficiency disease

ANS: C AIDS is caused by the human immunodeficiency virus, which primarily attacks the CD4+ T-cells. Wiskott- Aldrich syndrome, ITP, and severe combined immunodeficiency disease are not viral illnesses.

The nurse is teaching parents of a child with chronic renal failure (CRF) about the use of recombinant human erythropoietin (rHuEPO) subcutaneous injections. Which statement indicates the parents have understood the teaching? a. These injections will help with the hypertension. b. Were glad the injections only need to be given once a month. c. The red blood cell count should begin to improve with these injections. d. Urine output should begin to improve with these injections.

ANS: C Anemia in children with CRF is related to decreased production of erythropoietin. Recombinant human erythropoietin (rHuEPO) is being offered to these children as thrice-weekly or weekly subcutaneous injections and is replacing the need for frequent blood transfusions. The parents understand the teaching if they say that the red blood cell count will begin to improve with these injections.

An adolescent will receive a bone marrow transplant (BMT). The nurse should explain that the bone marrow will be administered by which route? a. Bone grafting b. Bone marrow injection c. Intravenous infusion d. Intraabdominal infusion

ANS: C Bone marrow from a donor is infused intravenously, not intraabdominally, and the transfused stem cells will repopulate the marrow. Because the stem cells migrate to the recipients marrow when given intravenously, this method of administration is used rather than bone grafting or bone marrow injection.

The nurse is teaching the parent about the diet of a child experiencing severe edema associated with acute glomerulonephritis. Which information should the nurse include in the teaching? a. You will need to decrease the number of calories in your childs diet. b. Your childs diet will need an increased amount of protein. c. You will need to avoid adding salt to your childs food. d. Your childs diet will consist of low-fat, low-carbohydrate foods.

ANS: C For most children, a regular diet is allowed, but it should contain no added salt. The child should be offered a regular diet with favorite foods. Severe sodium restrictions are not indicated.

Which statement best describes b-thalassemia major (Cooleys anemia)? a. All formed elements of the blood are depressed. b. Inadequate numbers of red blood cells are present. c. Increased incidence occurs in families of Mediterranean extraction. d. Increased incidence occurs in persons of West African descent.

ANS: C Individuals who live near the Mediterranean Sea and their descendants have the highest incidence of thalassemia. An overproduction of red cells occurs. Although numerous, the red cells are relatively unstable. Sickle cell disease is common in blacks of West African descent.

Iron dextran is ordered for a young child with severe iron deficiency anemia. Nursing considerations include: a. Administering with meals. b. Administering between meals. c. Injecting deeply into a large muscle. d. Massaging injection site for 5 minutes after administration of drug.

ANS: C Iron dextran is a parenteral form of iron. When administered intramuscularly, it must be injected into a large muscle using the Z-track method. Iron dextran is for intramuscular or intravenous administration; it is not taken orally. The site should not be massaged to prevent leakage, potential irritation, and staining of the skin.

What is most descriptive of the pathophysiology of leukemia? a. Increased blood viscosity occurs. b. Thrombocytopenia (excessive destruction of platelets) occurs. c. Unrestricted proliferation of immature white blood cells (WBCs) occurs. d. The first stage of the coagulation process is abnormally stimulated.

ANS: C Leukemia is a group of malignant disorders of the bone marrow and the lymphatic system. It is defined as an unrestricted proliferation of immature WBCs in the blood-forming tissues of the body. Increased blood viscosity may occur secondary to the increased number of WBCs. Thrombocytopenia may occur secondary to the overproduction of WBCs in the bone marrow. The coagulation process is unaffected by leukemia.

Which statement most accurately describes the pathologic changes of sickle cell anemia? A. Sickle-shaped cells carry excess oxygen. B. Sickle-shaped cells decrease blood viscosity. C. Increased red blood cell destruction occurs. D. Decreased red blood cell destruction occurs.

ANS: C The clinical features of sickle cell anemia are primarily the result of increased red blood cell destruction and obstruction caused by the sickle-shaped red blood cells. Sickled red cells have decreased oxygen-carrying capacity and transform into the sickle shape in conditions of low oxygen tension. When the sickle cells change shape, they increase the viscosity in the area where they are involved in the microcirculation.

A school-age child with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time. The most appropriate nursing action to prevent or minimize these reactions with subsequent treatments is to: a. Encourage drinking large amounts of favorite fluids. b. Encourage child to take nothing by mouth (remain NPO) until nausea and vomiting subside. c. Administer an antiemetic before chemotherapy begins. d. Administer an antiemetic as soon as child has nausea.

ANS: C The most beneficial regimen to minimize nausea and vomiting associated with chemotherapy is to administer the antiemetic before the chemotherapy is begun. The goal is to prevent anticipatory symptoms. Drinking fluids will add to the discomfort of the nausea and vomiting. Encouraging the child to remain NPO will help with this episode, but the child will have the discomfort and be at risk for dehydration. Administering an antiemetic after the child has nausea does not avoid anticipatory nausea.

The parents of a child with cancer tell the nurse that a bone marrow transplant (BMT) may be necessary. What should the nurse recognize as important when discussing this with the family? a. BMT should be done at time of diagnosis. b. Parents and siblings of child have a 25% chance of being a suitable donor. c. Finding a suitable donor involves matching antigens from the human leukocyte antigen (HLA) system. d. If BMT fails, chemotherapy or radiotherapy must be continued.

ANS: C The most successful BMTs come from suitable HLA-matched donors. The timing of a BMT depends on the disease process involved. It usually follows intensive high-dose chemotherapy and/or radiation therapy. Usually parents only share approximately 50% of the genetic material with their children. A one-in-four chance exists that two siblings will have two identical haplotypes and will be identically matched at the HLA loci. Discussing the continuation of chemotherapy or radiotherapy is not appropriate when planning the BMT. That decision will be made later.

When teaching the mother of a 9-month-old infant about administering liquid iron preparations, the nurse should include that: a. They should be given with meals. b. They should be stopped immediately if nausea and vomiting occur. c. Adequate dosage will turn the stools a tarry green color. d. Preparation should be allowed to mix with saliva and bathe the teeth before swallowing.

ANS: C The nurse should prepare the mother for the anticipated change in the childs stools. If the iron dose is adequate, the stools will become a tarry green color. The lack of the color change may indicate insufficient iron. The iron should be given in two divided doses between meals, when the presence of free hydrochloric acid is greatest. Iron is absorbed best in an acidic environment. Vomiting and diarrhea may occur with iron administration. If these occur, the iron should be given with meals, and the dosage reduced and gradually increased as the child develops tolerance. Liquid preparations of iron stain the teeth. They should be administered through a straw, and the mouth rinsed after administration.

A child is 2 hours postoperative after a resection of a brain tumor. Which assessment by the nurse takes priority? a. Blood pressure b. Intake and output c. Neurological exam d. Temperature

ANS: C All actions are appropriate for a child postoperatively. However, the answer that is most specific to this childs procedure is the neurological exam.

A nursing faculty member explains to the class that which item is the most important for tumor cell growth? a. Age of transforming cells b. Programmed cell death c. Proximity to a capillary d. Rapidity of cell growth

ANS: C All cells, including tumor cells, need a consistent supply of oxygen and nutrients, delivered via the capillaries. Neoplastic cells must be in close enough proximity to a capillary to provide these required elements. The other factors do not have such an important role, if any, in neoplastic growth.

A nurse is caring for four patients who have Hodgkins lymphoma. Which child should the nurse see first? a. Anorexia for a week b. Enlarged cervical lymph nodes c. Fever of 102.1F (38.9C) d. Mediastinal mass

ANS: C All options are possible manifestations of Hodgkins lymphoma. However, the child with a fever may have another cause for the temperature, including infection, that needs to be ruled out. This is especially true of a child receiving chemotherapy, a standard treatment for this disorder.

A nursing student asks the faculty member to explain an oncogene. Which response by the faculty member is the most appropriate? a. A cell that changes into a malignancy after environmental stress b. Any gene found inside a solid tumor that can be removed for biopsy c. A gene in a virus that encourages malignant transformation in cells d. An inherited gene that is programmed to become a malignant cell

ANS: C An oncogene is a gene found inside a virus that has the ability to encourage a normal cell to become malignant.

Which child should the nurse document as being anemic? a. 7-year-old child with a hemoglobin of 11.5 g/dL b. 3-year-old child with a hemoglobin of 12 g/dL c. 14-year-old child with a hemoglobin of 10 g/dL d. 1-year-old child with a hemoglobin of 13 g/dL

ANS: C Anemia is a condition in which the number of red blood cells, or hemoglobin concentration, is reduced below the normal values for age. Anemia is defined as a hemoglobin level below 10 or 11 g/dL. The child with a hemoglobin of 10 g/dL would be considered anemic. The normal hemoglobin for a child after 2 years of age is 11.5 to 15.5 g/dL.

The nurse is planning activity for a 4-year-old child with anemia. Which activity should the nurse plan for this child? a. Game of hide and seek in the childrens outdoor play area b. Participation in dance activities in the playroom c. Puppet play in the childs room d. A walk down to the hospital lobby

ANS: C Because the basic pathologic process in anemia is a decrease in oxygen-carrying capacity, an important nursing responsibility is to assess the childs energy level and minimize excess demands. The childs level of tolerance for activities of daily living and play is assessed, and adjustments are made to allow as much self-care as possible without undue exertion. Puppet play in the childs room would not be overly tiring. Hide and seek, dancing, and walking to the lobby would not conserve the anemic childs energy.

An 8-year-old child has been diagnosed with a brain tumor. Based on knowledge of childhood cancers, which intervention does the nurse plan to implement when the child is admitted to the hospital? a. Aspiration precautions b. Protective isolation c. Safety precautions d. Seizure precautions

ANS: C Brain tumors in children 1 to 10 years of age are usually infratentorial and involve the brainstem and cerebellum. Manifestations of brainstem tumors result from involvement of the cranial nerves and include hemiparesis, spastic gait, and frequent stumbling and falling. The nurse implements safety precautions for this child. The other precautions may or may not be needed depending on the childs specific condition, treatment, and side effects of treatment.

A clinic nurse notes that a child brought in for a physical has swelling and bruising around the eyes. The patient denies any trauma and the parent reports no environmental allergies. Which assessment is most important? a. Auscultate lungs bilaterally. b. Inspect skin on the back. c. Palpate abdomen and neck. d. Percuss abdomen and flank.

ANS: C Swelling and bruising around the face and eyes is often seen in children with neuroblastoma. Most commonly the tumor can be found by palpation of the abdomen or neck, where the tumor will present as a hard, painless mass that crosses the midline.

A child is in the hospital receiving chemotherapy for Hodgkins lymphoma. What action by a new nurse causes the precepting nurse to intervene? a. Assesses the need for anti-emetics prior to starting chemotherapy b. Checks the IV for blood return before giving the chemotherapy c. Double wraps the chemotherapy bags and places in the trash can d. Performs hand hygiene prior to and after caring for the patient

ANS: C Chemotherapeutic agents are considered hazardous waste and must be disposed of in specific containers, not the trash can. The other actions are appropriate.

A major complication in a child with chronic renal failure is: a. Hypokalemia. b. Metabolic alkalosis. c. Water and sodium retention. d. Excessive excretion of blood urea nitrogen.

ANS: C Chronic renal failure leads to water and sodium retention, which contributes to edema and vascular congestion. Hyperkalemia, metabolic acidosis, and retention of blood urea nitrogen are complications of chronic renal failure.

The diet of a child with chronic renal failure is usually characterized as: a. High in protein. b. Low in vitamin D. c. Low in phosphorus. d. Supplemented with vitamins A, E, and K.

ANS: C Dietary phosphorus is controlled to prevent or control the calcium/phosphorus imbalance by the reduction of protein and milk intake. Protein should be limited in chronic renal failure to decrease intake of phosphorus. Vitamin D therapy is administered in chronic renal failure to increase calcium absorption. Supplementation with vitamins A, E, and K is not part of dietary management in chronic renal disease.

A nurse is caring for a child who has acute lymphocytic leukemia and has been treated with doxorubicin (Adriamycin). Which assessment finding would the nurse report immediately? a. Loss of appetite b. Low WBC count c. Peripheral edema d. Temperature of 100.6F (38.1C), once

ANS: C Doxorubicin and other anthracycline drugs are known to cause heart damage. Peripheral edema may signal heart failure and should be reported right away. Loss of appetite and low WBC count are common findings for a child on chemotherapy. A single temperature of 100.6F does not need to be reported.

A 7-year-old child presents to the emergency department, where the parent reports a 3-week history of pale skin, extreme fatigue, and dizziness. Which laboratory value would the nurse correlate with the patients current condition? a. Hematocrit: 33% b. Hemoglobin: 13.2 g/dL c. Red blood cell count: 2.8/mm3 d. White blood cell count: 12.3/mm3

ANS: C For a child of this age, a normal RBC count is 45.2/mm3. Low RBCs can lead to pallor, fatigue, headaches, and dizziness, as tissues are not being oxygenated. The other laboratory values are normal.

The most appropriate nursing diagnosis for the child with acute glomerulonephritis is: a. Risk for Injury related to malignant process and treatment. b. Deficient Fluid Volume related to excessive losses. c. Excess Fluid Volume related to decreased plasma filtration. d. Excess Fluid Volume related to fluid accumulation in tissues and third spaces.

ANS: C Glomerulonephritis has a decreased filtration of plasma. The decrease in plasma filtration results in an excessive accumulation of water and sodium that expands plasma and interstitial fluid volumes, leading to circulatory congestion and edema. No malignant process is involved in acute glomerulonephritis. A fluid volume excess is found. The fluid accumulation is secondary to the decreased plasma filtration, not fluid accumulation.

Children receiving long-term systemic corticosteroid therapy are most at risk for: a. Hypotension. b. Dilation of blood vessels in the cheeks. c. Growth delays. d. Decreased appetite and weight loss.

ANS: C Growth delay is associated with long-term steroid use. Hypertension is a clinical manifestation of long-term systemic steroid administration. Dilation of blood vessels in the cheeks is associated with an excess of topically administered steroids. Increased appetite and weight gain are clinical manifestations of excess systemic corticosteroid therapy.

A nurse is looking at photographs of a friends infant. The nurse notes a whitish glow in the childs eyes, and the friend asks why the babys eyes look so odd. Which response by the nurse is the most appropriate? a. If his eyes look like this by 6 months, he needs to see a doctor. b. Take him to the doctor to see whats wrong with his eyes. c. This is called leukocoria and may signify retinoblastoma. d. Your baby may have a brain tumor; take him to the hospital.

ANS: C Leukocoria (also known as the cats-eye reflex) is a whitish glow in the pupil, often noticed on photographs, and is seen in children with retinoblastoma. The child needs to be seen by his health-care provider. The mother should not wait 6 months. Advising the mother to find out whats wrong with his eyes is not as accurate as explaining the manifestation. This sign is not seen in brain tumors.

A child is receiving chemotherapy. The nurse assesses the childs oral cavity and notes the following: raspy voice, thick saliva, and debris on the teeth. Which action by the nurse is the most appropriate? a. Have the child use commercial mouthwash. b. Hold the next dose of chemotherapy. c. Increase the frequency of oral care. d. Place the child on NPO status.

ANS: C Mucositis is a diffuse inflammation of the mouth and oral mucous membranes, and is common during chemotherapy. The nurse should increase the frequency of oral care in the child who is manifesting signs of this problem. Commercial mouthwash contains alcohol, which would burn the tissues. The chemotherapy would not be interrupted. The child should be encouraged to eat and drink as tolerated.

A child needs surgery to resect a tumor, but is scheduled for several weeks of radiation therapy first. The parents are frustrated and want to know why the surgery that can cure the cancer is being delayed. Which response by the nurse is the most appropriate? a. Children who have radiation first generally do better than others. b. If the radiation destroys the tumor, surgery will not be needed. c. Radiation will shrink the tumor, making it easier to get all of it out. d. The surgeons must be worried that they cannot get the whole tumor.

ANS: C Often radiation or chemotherapy is used prior to surgical resection to shrink the size of the tumor, maximizing the chances of complete removal. The other responses are not accurate.

A parent brings a 10-year-old child to the clinic, reporting that the child fell while playing and now has a limp several days later. In completing a history, which other finding would the nurse correlate more with bone cancer than a minor trauma? a. Decreased appetite for the last month b. Fatigues easily when playing outdoors c. Limping several weeks prior to the fall d. Often has unexplained extremity bruises

ANS: C Pain and swelling are the most common manifestations of osteosarcoma. Often the child has a limp. The child also may have a dull pain at the tumor site, and if it is on a leg (weight-bearing), it could easily cause a limp that has lasted for several weeks before really being noticed. The other manifestations are vague and could be related to other problems.

Several blood tests are ordered for a preschool child with severe anemia. She is crying and upset because she remembers the venipuncture done at the clinic 2 days ago. The nurse should explain that: a. Venipuncture discomfort is very brief. b. Only one venipuncture will be needed. c. Topical application of local anesthetic can eliminate venipuncture pain. d. Most blood tests on children require only a finger puncture because a small amount of blood is needed.

ANS: C Preschool children are very concerned about both pain and the loss of blood. When preparing the child for venipuncture, a topical anesthetic will be used to eliminate any pain. This is a very traumatic experience for preschool children. They are concerned about their bodily integrity. A local anesthetic should be used, and a bandage should be applied to maintain bodily integrity. A promise that only one venipuncture will be needed should not be made in case multiple attempts are required. Both finger punctures and venipunctures are traumatic for children. Both require preparation.

A nurse sees the term proptosis in a childs medical record. Which physical assessment does the nurse plan to incorporate into the childs exam based on this finding? a. Balance testing b. Hearing screen c. Visual acuity d. Strength testing

ANS: C Proptosis is a downward displacement of the eyeball that can affect visual acuity and is frequently seen in children with rhabdomyosarcoma. The other assessments are not related.

As related to inherited disorders, which statement is descriptive of most cases of hemophilia? a. Autosomal dominant disorder causing deficiency in a factor involved in the blood-clotting reaction b. X-linked recessive inherited disorder causing deficiency of platelets and prolonged bleeding c. X-linked recessive inherited disorder in which a blood-clotting factor is deficient d. Y-linked recessive inherited disorder in which the red blood cells become moon shaped

ANS: C The inheritance pattern in 80% of all of the cases of hemophilia is X-linked recessive. The two most common forms of the disorder are factor VIII deficiency (hemophilia A or classic hemophilia), and factor IX deficiency (hemophilia B or Christmas disease). The disorder involves coagulation factors, not platelets. The disorder does not involve red cells or the Y chromosome.

A nurse hears that a new admission to the hospital was recently diagnosed with the most common kind of childhood cancer. Which collaborative care does the nurse prepare to provide to this patient? a. Antibiotic administration b. Bone marrow transplant c. Chemotherapy d. Liver transplant

ANS: C The most common type of childhood cancer is acute lymphocytic leukemia (ALL). First-line treatment for ALL is inducing remission with chemotherapy. Antibiotics are not used unless the child has an infection. Bone marrow transplant may be considered later in the childs course of care. A liver transplant would not be a treatment for ALL.

The nurse is admitting a school-age child in acute renal failure with reduced glomerular filtration rate. Which urine test is the most useful clinical indication of glomerular filtration rate? a. pH b. Osmolality c. Creatinine clearance d. Protein level

ANS: C The most useful clinical indication of glomerular filtration is the clearance of creatinine. It is a substance that is freely filtered by the glomerulus and secreted by the renal tubule cells. The pH and osmolality are not estimates of glomerular filtration. Although protein in the urine demonstrates abnormal glomerular permeability, it is not a measure of filtration rate.

A child has cancer, is unresponsive, and is doing poorly. Which action by the nursing student causes the faculty to intervene? a. Allows the parents to hold the child b. Places the child on NPO status c. Takes the childs rectal temperature d. Turns the child even if she moans

ANS: C The nurse avoids the rectal route for anything: temperatures, suppositories, and enemas are not allowed, as the rectal mucosa is fragile and prone to injury, which can lead to infection. The other actions are appropriate.

A nurse notes in a patients medical record high levels of vanillymandelic acid (VMA). Based on this information, which condition does the nurse prepare to educate the patient and family about? a. Ewings sarcoma b. Hodgkins lymphoma c. Neuroblastoma d. Wilms tumor

ANS: C VMA and homovanillic acid (HVA) are tests used to measure the level of catecholamine metabolites in the urine. Neuroblastomas typically secrete catecholamines, so high levels of either substance are indicative of neuroblastoma.

A nursing student is caring for a child diagnosed with Wilms tumor. Which action by the student causes the faculty member to intervene? a. Assesses urinary output per protocol b. Involves the parents in the childs care c. Palpates the abdomen in all four quadrants d. Provides frequent nutritious snacks

ANS: C Wilms tumor is a solid, encapsulated mass that can rupture with palpation. Once the child is diagnosed with this cancer, palpation of the childs abdomen is prohibited. The other actions are appropriate.

An accurate description of anemia is: A. Increased blood viscosity. B. Depressed hematopoietic system. C. Presence of abnormal hemoglobin. D. Decreased oxygen-carrying capacity of blood.

ANS: D Anemia is a condition in which the number of red blood cells or hemoglobin concentration is reduced below the normal values for age. This results in a decreased oxygen-carrying capacity of blood. Increased blood viscosity is usually a function of too many cells or of dehydration, not of anemia. A depressed hematopoietic system or abnormal hemoglobin can contribute to anemia, but the definition depends on the deceased oxygen- carrying capacity of the blood.

Which clinical manifestation should the nurse expect when a child with sickle cell anemia experiences an acute vaso-occlusive crisis? a. Circulatory collapse b. Cardiomegaly, systolic murmurs c. Hepatomegaly, intrahepatic cholestasis d. Painful swelling of hands and feet, painful joints

ANS: D A vaso-occlusive crisis is characterized by severe pain in the area of involvement. If in the extremities, painful swelling of the hands and feet is seen; if in the abdomen, severe pain resembles that of acute surgical abdomen; and if in the head, stroke and visual disturbances occur. Circulatory collapse results from sequestration crises. Cardiomegaly, systolic murmurs, hepatomegaly, and intrahepatic cholestasis result from chronic vaso- occlusive phenomena.

The nurse is preparing a child for possible alopecia from chemotherapy. Which suggestion should be included in the teaching? a. Explaining to the child that hair usually regrows in 1 year. b. Advising the child to expose the head to sunlight to minimize alopecia. c. Explaining to the child that wearing a hat or scarf is preferable to wearing a wig. d. Explaining to the child that, when hair regrows, it may have a slightly different color or texture.

ANS: D Alopecia is a side effect of certain chemotherapeutic agents. When the hair regrows, it may be of different color or texture. The hair usually grows back within 3 to 6 months after the cessation of treatment. The head should be protected from sunlight to avoid sunburn. Children should choose the head covering that they prefer.

A mother asks the nurse what would be the first indication that acute glomerulonephritis is improving. The nurses best response should be that the: a. Blood pressure will stabilize. b. Child will have more energy. c. Urine will be free of protein. d. Urinary output will increase.

ANS: D An increase in urinary output may signal resolution of the acute glomerulonephritis. If blood pressure is elevated, stabilization usually occurs with the improvement in renal function. The child having more energy and the urine being free of protein are related to the improvement in urinary output.

The nurse is recommending how to prevent iron deficiency anemia in a healthy, term, breastfed infant. What should she or he suggest? a. Iron (ferrous sulfate) drops after age 1 month. b. Iron-fortified commercial formula can be used by ages 4 to 6 months. c. Iron-fortified infant cereal can be introduced at age 2 months. d. Iron-fortified infant cereal can be introduced at approximately 6 months of age.

ANS: D Breast milk supplies inadequate iron for growth and development after age 5 months. Supplementation is necessary at this time. Iron supplementation or the introduction of solid foods in a breastfed baby is not indicated. Introducing iron-fortified infant cereal at 2 months should be done only if the mother is choosing to discontinue breastfeeding.

The pediatric nurse is caring for an adolescent with cancer. The parents are interested in exploring complementary and alternative (CAM) therapies. Which response by the nurse is the most appropriate? a. Be careful; many CAM providers prey on desperation. b. CAM therapies have worked well for many cancer patients. c. These treatments only provide relief through a placebo effect. d. Although many people like CAM, many therapies have not been researched.

ANS: D CAM therapies are used by many people and include natural products, mindbody medicine, and manipulative and body practices. One controversy surrounding CAM practices is that many of the therapies have not been researched. The nurse wishes to remain supportive of the family while giving objective information. Telling the family that many people do have success with CAM but advising them that many modalities have not been researched accomplishes both objectives. The other statements either may scare, discourage, or not provide information to the family.

A child with leukemia is receiving triple intrathecal chemotherapy consisting of methotrexate, cytarabine, and hydrocortisone. The purpose of this is to prevent: a. Infection. b. Brain tumor. c. Drug side effects. d. Central nervous system (CNS) disease.

ANS: D For certain children, CNS prophylactic therapy is indicated. This drug regimen is used to prevent CNS leukemia. This regimen does not prevent infection or drug side effects. If the child has a brain tumor in addition to leukemia, additional therapy would be indicated.

An acquired hemorrhagic disorder that is characterized by excessive destruction of platelets is: a. Aplastic anemia. b. Thalassemia major. c. Disseminated intravascular coagulation. d. Idiopathic thrombocytopenic purpura.

ANS: D Idiopathic thrombocytopenic purpura is an acquired hemorrhagic disorder characterized by an excessive destruction of platelets, discolorations caused by petechiae beneath the skin, and a normal bone marrow. Aplastic anemia refers to a bone marrow failure condition in which the formed elements of the blood are simultaneously depressed. Thalassemia major is a group of blood disorders characterized by deficiency in the production rate of specific hemoglobin globin chains. Disseminated intravascular coagulation is characterized by diffuse fibrin deposition in the microvasculature, consumption of coagulation factors, and endogenous generation of thrombin and plasma.

The nurse is caring for an adolescent who has just started dialysis. The child seems always angry, hostile, or depressed. The nurse should recognize that this is most likely related to: A. Neurologic manifestations that occur with dialysis. B. Physiologic manifestations of renal disease. C. Adolescents having few coping mechanisms. D. Adolescents often resenting the control and enforced dependence imposed by dialysis.

ANS: D Older children and adolescents need control. The necessity of dialysis forces the adolescent into a dependent relationship, which results in these behaviors. Neurologic manifestations that occur with dialysis and physiologic manifestations of renal disease are a function of the age of the child, not neurologic or physiologic manifestations of the dialysis. Adolescents do have coping mechanisms, but they need to have some control over their disease management.

An advantage of peritoneal dialysis is that: a. Treatments are done in hospitals. b. Protein loss is less extensive. c. Dietary limitations are not necessary. d. Parents and older children can perform treatments.

ANS: D Peritoneal dialysis is the preferred form of dialysis for parents, infants, and children who wish to remain independent. Parents and older children can perform the treatments themselves. Treatments can be done at home. Protein loss is not significantly different. The dietary limitations are necessary, but they are not as stringent as those for hemodialysis.

Myelosuppression associated with chemotherapeutic agents or some malignancies such as leukemia can cause bleeding tendencies because of a/an: a. Decrease in leukocytes. b. Increase in lymphocytes. c. Vitamin C deficiency. d. Decrease in blood platelets.

ANS: D The decrease in blood platelets secondary to the myelosuppression of chemotherapy can cause an increase in bleeding. The child and family should be alerted to avoid risk of injury. Decrease in leukocytes, increase in lymphocytes, and vitamin C deficiency would not affect bleeding tendencies.

An 8-year-old girl is receiving a blood transfusion when the nurse notes that she has developed precordial pain, dyspnea, distended neck veins, slight cyanosis, and a dry cough. These manifestations are most suggestive of: a. Air embolism. b. Allergic reaction. c. Hemolytic reaction. d. Circulatory overload.

ANS: D The signs of circulatory overload include distended neck veins, hypertension, crackles, dry cough, cyanosis, and precordial pain. Signs of air embolism are sudden difficulty breathing, sharp pain in the chest, and apprehension. Allergic reactions are manifested by urticaria, pruritus, flushing, asthmatic wheezing, and laryngeal edema. Hemolytic reactions are characterized by chills, shaking, fever, pain at infusion site, nausea, vomiting, tightness in chest, flank pain, red or black urine, and progressive signs of shock and renal failure.

Which immunization should not be given to a child receiving chemotherapy for cancer? a. Tetanus vaccine b. Inactivated poliovirus vaccine c. Diphtheria, pertussis, tetanus (DPT) d. Measles, rubella, mumps

ANS: D The vaccine used for measles, mumps, and rubella is a live virus and can result in an overwhelming infection. Tetanus vaccine, inactivated poliovirus vaccine, and DPT are not live virus vaccines.

A preschool child is being admitted to the hospital with dehydration and a urinary tract infection (UTI). Which urinalysis result should the nurse expect with these conditions? a. WBC <1; specific gravity 1.008 b. WBC <2; specific gravity 1.025 c. WBC >2; specific gravity 1.016 d. WBC >2; specific gravity 1.030

ANS: D The white blood cell count (WBC) in a routine urinalysis should be <1 or 2. Over that amount indicates a urinary tract inflammatory process. The urinalysis specific gravity for children with normal fluid intake is 1.016 to 1.022. When the specific gravity is high, dehydration is indicated. A low specific gravity is seen with excessive fluid intake, distal tubular dysfunction, or insufficient antidiuretic hormone secretion.

A student nurse wants to provide nonpharmacological pain management interventions to a hospitalized child with cancer. Which action by the student causes the faculty member to intervene? a. Applying a moist heat pack b. Giving the child a massage c. Reading the child a story d. Using candles for aromatherapy

ANS: D Actions that have been reported by children to be effective pain control strategies are moist heat, massage, adequate rest and sleep, distraction (reading a story), and providing opportunities for social support. Open flames are prohibited in hospitals due to the risk of fire and explosion.

Which clinical manifestation would be seen in a child with chronic renal failure? a. Hypotension b. Massive hematuria c. Hypokalemia d. Unpleasant uremic breath odor

ANS: D Children with chronic renal failure have a characteristic breath odor resulting from the retention of waste products. Hypertension may be a complication of chronic renal failure. With chronic renal failure, little or no urine output occurs. Hyperkalemia is a concern in chronic renal failure.

Which intervention is appropriate when examining a male infant for cryptorchidism? a. Cooling the examiners hands b. Taking a rectal temperature c. Eliciting the cremasteric reflex d. Warming the room

ANS: D For the infants comfort, the infant should be examined in a warm room with the examiners hands warmed. Testes can retract into the inguinal canal if the infant is upset or cold. Examining the infant with cold hands is uncomfortable for the infant and likely to cause the infants testes to retract into the inguinal canal. It may also cause the infant to be uncooperative during the examination. A rectal temperature yields no information about cryptorchidism. Testes can retract into the inguinal canal if the cremasteric reflex is elicited. This can lead to an incorrect diagnosis.

The nurse is caring for a child with acute renal failure. What clinical manifestation should he or she recognize as a sign of hyperkalemia? a. Dyspnea b. Seizure c. Oliguria d. Cardiac arrhythmia

ANS: D Hyperkalemia is the most common threat to the life of the child. Signs of hyperkalemia include electrocardiographic anomalies such as prolonged QRS complex, depressed ST segments, peaked T waves, bradycardia, or heart block. Dyspnea, seizure, and oliguria are not manifestations of hyperkalemia.

The nurse is assisting the pediatric provider with a newborn examination. The provider notes that the infant has hypospadias. The nurse understands that hypospadias refers to: a. Absence of a urethral opening. b. Penis shorter than usual for age. c. Urethral opening along dorsal surface of penis. d. Urethral opening along ventral surface of penis.

ANS: D Hypospadias is a congenital condition in which the urethral opening is located anywhere along the ventral surface of the penis. The urethral opening is present, but not at the glans. Hypospadias does not refer to the size of the penis. When the urethral opening is along the dorsal surface of the penis, it is known as epispadias.

Which diagnostic finding is present when a child has primary nephrotic syndrome? a. Hyperalbuminemia b. Positive ASO titer c. Leukocytosis d. Proteinuria

ANS: D Large amounts of protein are lost through the urine as a result of an increased permeability of the glomerular basement membrane. Hypoalbuminemia is present because of loss of albumin through the defective glomerulus and the livers inability to synthesize proteins to balance the loss. ASO titer is negative in a child with primary nephrotic syndrome. Leukocytosis is not a diagnostic finding in primary nephrotic syndrome.

A child has nausea after chemotherapy despite anti-emetics. However, the child complains that my tummy is growling. Which other action should the nurse take to promote comfort for this child? a. Avoid hard, difficult-to-chew foods. b. Encourage a high fluid intake with meals. c. Offer the child hard candy to suck on. d. Provide bland items, such as plain mashed potatoes.

ANS: D Several actions can help the child with nausea: offering plain, bland foods; avoiding spicy, heavy, or fatty foods; decreasing the odor associated with foods if that bothers the child; and having the child take food separately from liquids. Liquid together with food can make the child feel full, inducing nausea. The other options are good choices for other nutritional problems.

A common side effect of corticosteroid therapy is: a. Fever. b. Hypertension. c. Weight loss. d. Increased appetite.

ANS: D Side effects of corticosteroid therapy include an increased appetite. Fever is not a side effect of therapy. It may be an indication of infection. Hypertension is not usually associated with initial corticosteroid therapy. Weight gain, not weight loss, is associated with corticosteroid therapy.

Several complications can occur when a child receives a blood transfusion. An immediate sign or symptom of an air embolus is: a. Chills and shaking. b. Nausea and vomiting. c. Irregular heart rate. d. Sudden difficulty in breathing.

ANS: D Signs of air embolism are sudden difficulty breathing, sharp pain in the chest, and apprehension. Air emboli should be avoided by carefully flushing all tubing of air before connecting to the patient. Chills, shaking, nausea, and vomiting are associated with hemolytic reactions. Irregular heart rate is associated with electrolyte disturbances and hypothermia.

The parents of a child with cancer ask the nurse why the child is losing weight even though he is eating what he normally does. Which response by the nurse is the most appropriate? a. Cancer consumes body tissues, causing weight loss. b. He may be going through a growth spurt right now. c. How do you know he is eating like he normally does? d. When you are sick, you need more nutrition than usual.

ANS: D The demands of illness lead to increased nutritional needs. A child with cancer needs increased nutrition. Cancer does not consume body tissues. The child may be going through a growth spurt, but this is not always the case and is not the best answer. Asking the parents how they know the childs eating habits have changed may put them on the defensive.

The most common cause of acute renal failure in children is: a. Pyelonephritis. b. Tubular destruction. c. Urinary tract obstruction. d. Severe dehydration.

ANS: D The most common cause of acute renal failure in children is dehydration or other causes of poor perfusion that may respond to restoration of fluid volume. Pyelonephritis and tubular destruction are not common causes of acute renal failure in children. Obstructive uropathy may cause acute renal failure, but it is not the most common cause.

A child has been diagnosed with chronic myelogenous leukemia (CML). Which statement by the nurse to the parents is most appropriate? a. Radiation therapy is the standard treatment. b. The prognosis for this disease is extremely poor. c. There are lots of good medications for nausea. d. We need to test siblings for a bone marrow match.

ANS: D The preferred treatment for CML is a bone marrow or stem cell transplant from a matching sibling, which can be curative in up to 80% of patients. Radiation therapy is not used. Although there are many good medications for nausea, this statement is not the best choice, because it is not specific to this childs condition.

A nurse works on the pediatric oncology floor. After receiving the handoff report, which child does the nurse assess first? a. Child on protective isolation b. 4 hours postbone marrow biopsy c. Not eating an hour after chemotherapy d. Temperature of 101.5F (38.5C)

ANS: D This fever indicates a probable infection. The nurse will see this child first and provide report to the physician, if this has not already been done. This child is the sickest and should be seen first; one might be tempted to see the child in protective isolation first to avoid cross-contamination, but by following isolation precautions, this risk is minimized. Not eating after chemotherapy is not cause for concern, and the child 4 hours postbone marrow biopsy should be stable.

A child with secondary enuresis who complains of dysuria or urgency should be evaluated for what condition (Select all that apply)? a. Hypocalciuria b. Nephrotic syndrome c. Glomerulonephritis d. Urinary tract infection (UTI) e. Diabetes mellitus

ANS: D, E Complaints of dysuria or urgency from a child with secondary enuresis suggest the possibility of a UTI. If accompanied by excessive thirst and weight loss, these symptoms may indicate the onset of diabetes mellitus. An excessive loss of calcium in the urine (hypercalciuria) can be associated with complaints of painful urination, urgency, frequency, and wetting. Nephrotic syndrome is not usually associated with complaints of dysuria or urgency. Glomerulonephritis is not a likely cause of dysuria or urgency.