PEDS Practice: CH 46

A 3-year-old child who was burned severely in a car accident is getting near the end of the basic healing of their wounds and needs to have her dressing changed. To help this toddler develop a sense of autonomy, which intervention may the nurse encourage the child to perform during the dressing change? a. Allow the child to put the tape in place at the end of the sterile dressing change. b. Even though there is still a lot of drainage, allow the child to remove and dispose of the saturated old bandage. c. Encourage the parents to distract the child once the wound comes into view to prevent nightmares. d. Allow the child to keep some of the sterile bandages and some tape to play with after the nurse leaves the room.

Allow the child to put the tape in place at the end of the sterile dressing change.

How can the nurse most simply describe for distressed parents a rhabdomyosarcoma that has been found in their 5-year-old?

Call it a tumor of muscle tissue A rhabdomyosarcoma is a tumor of striated muscle that most commonly develops in the head, neck, arms, and legs, as well as in the genitourinary tract, of children. The other descriptors are incorrect

A nurse is counseling parents of a 7-year-old boy with leukemia regarding the goals of the chemotherapy program for their son. What should she mention as the first goal?

Complete absence of leukemia cells

A 6-month-old girl is seen with retinoblastoma. When taking a health history from her father, which symptom would you expect him to report he has noticed? a. One pupil appears white. b. The infant tugs and pulls at one ear. c. The infant's eye appears to be protruding. d. The infant always keeps her eyes tightly closed.

He has noticed one pupil appears white. As the tumor grows against the retina of the eye, the red reflex is no longer visible; the pupil appears white.

A nurse is preparing a 7-year-old girl for bone marrow aspiration. Which site should she prepare? Iliac crest Sternum Anterior tibia Femur

Iliac crest

A child with leukemia is receiving methotrexate for therapy. Which nursing diagnosis should the nurse use to best guide this child's care at this time? a. Excess fluid volume related to effect of methotrexate on aldosterone secretion b. Risk for self-directed violence related to effect of methotrexate on central nervous system c. Risk for impaired mobility related to depressant effects of methotrexate d. Impaired oral mucous membrane related to effects of chemotherapy

Impaired oral mucous membrane related to effects of chemotherapy

The nurse is caring for a 5-year-old boy undergoing radiation treatment for neuroblastoma. Which nursing diagnosis would be most applicable for this child?

Impaired skin integrity related to desquamation from cellular destruction

The nurse prepares to collect a 24-hour urine specimen for catecholamines from the child admitted with which likely childhood cancer diagnosis? a. Wilms tumor!! b. Retinoblastoma!! c. Neuroblastoma!! d. Osteogenic sarcoma!!

Neuroblastoma!!

Parents ask why their child is receiving prednisone to treat leukemia, because it is not a chemotherapy drug. How should the nurse answer?

Prednisone decreases swelling caused by dead or dying cancer cells. Prednisone is not a chemotherapeutic agent, but a hormone and it is given in conjunction with chemotherapy to decrease edema caused by tumor necrosis or the tumor. Reducing inflammation, stimulating appetite, and promoting weight gain are some actions and possible side effects of prednisone but do not provide the reason why the medication is used to treat leukemia.

The nurse is caring for a 17-year-old girl in the terminal phase of osteosarcoma. Which action demonstrates integration of the recommendations of the American Academy of Pediatrics (AAP) Committee on Bioethics? a. Allowing the child to listen during discussions of the care plan b. Explaining the prognosis using accepted clinical terminology c. Telling the child exactly what to expect of further treatments d. Encouraging the child to support the wishes of her parents

Telling the child exactly what to expect of further treatments

The nurse is teaching the parents of a 15-year-old boy who is being treated for acute myelogenous leukemia about the side effects of chemotherapy. For which symptoms should the parents seek medical care immediately?

Temperature of 101° F (38.3° C) or greater

Before the nurse starts the intravenous pyelogram to see if her patient has WIlm's Disease, what does she need to do first? 1. assess urine output 2. check for allergies 3. assess abdominal area 4. take vital signs

check for allergies

Which lab test would the nurse likely expect to find in a child diagnosed with Wilms tumor? (select all) 1. creatine: liver test 2. BUN: kidney test 3. hematuria or leukocytes: urine analysis 4. sodium level 60 mEq

creatine: liver test BUN: kidney test hematuria or leukocytes: urine analysis

When do you give CNS prophylaxis?

during each stage of chemotherapy

Signs and symptoms of Wilm's tumor

hematuria, HTN, fever, abdominal swelling, palpable mass

Treatment for Osteosarcoma involves

surgery to remove tumor or amputate, and chemotherapy

Treatment for Ewing Sarcoma involves

surgery to remove tumor, radiation, and chemotherapy

What is induction stage?

1st month of chemotherapy to induce rapid remission by reducing immature blast cells in bone marrow

When do we do stem cell transplants for Acute Lymphoblastic Leukemia patients?

if they relapse, so during consolidation or maintenance stage

What does the nurse need to monitor in a patient with Wilm's tumor?

urine output (hematuria) and blood pressure (HTN)

What is the best response by the nurse to the parents of a child with leukemia who express guilt because they did not take immediate action when their child seemed to develop one respiratory infection after another?

"Keep in mind that the signs of leukemia are often subtle and difficult to recognize." Pointing out that the signs and symptoms of leukemia are often difficult to recognize indicates to the parents that they were not neglectful, while also providing information about the disease. The other responses minimize the parents' feelings or tell them how they should feel and are not therapeutic.

A 9-year-old child with leukemia is scheduled to undergo an allogenic hematopoietic stem cell transplant. When teaching the child and parents, what information would the nurse include?

"We'll need to have a match to a donor."

The nurse is caring for a 14-year-old client scheduled for magnetic resonance imaging (MRI). The nurse explains the test to the child and family. Which information would be most appropriate to include in the explanation? a. "The MRI uses radio waves and magnets to produce a computerized image of the body." b. "The MRI is a nuclear scanning test to rule out cancer involving the bones or determine extent of bone involvement." c. "The MRI uses sound waves to create images that visualize body structures and locate masses." d. "The MRI uses radiation to examine soft tissue and bony structures of the body."

"The MRI uses radio waves and magnets to produce a computerized image of the body."

A child is to receive an oral corticosteroid as part of the treatment regimen for leukemia. After teaching the child and family about this drug, the nurse determines the need for additional teaching when they state: a. "We should check our son's urine for glucose." b. "We will need to gradually decrease the dosage." c. "He might develop a rounded face from this drug." d. "We should administer the drug on an empty stomach."

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

When explaining the procedure of bone marrow aspiration to a child with leukemia, what would be the best explanation?

"You will feel pressure on your hip from the needle." Bone marrow aspiration requires hard pressure to allow the needle to puncture the bone. It is usually done under local anesthesia or conscious sedation.

Treatment for retinoblastoma are the following 1. Radiation 2. Enucleation 3. Chemotherapy 4. Biopsy

- Radiation - Enucleation - Chemotherapy

A child has been diagnosed with acute lymphocytic leukemia (ALL). The nurse knows that which possible complication can occur? Select all that apply.

- blindness -renal impairment - infections - epistaxis - bone pain - infertility

ALL is classified according to what type of cells involved (select all) 1. —T cell 2. B cell 3. D cell 4. C cell

-T cell, B cell (early pre-B cell and pre-B cel)l

Examination of a child reveals a palpable abdominal mass. A diagnosis of neuroblastoma is suspected. When reviewing the child's history and physical examination, which would the nurse expect to find? Select all that apply.

-flushing -constipation

A nurse is reviewing the laboratory test results of a 3-year-old child. Which absolute neutrophil count would the nurse identify as indicating neutropenia? a. 2.5 b. 1.5 c. 2.0 d. 1.0

1.0

How long are patients usually on maintenance treatment?

2 to 3 years (so they can maintain remission and prevent relapse)

Wilm's disease can occur in which type of patient? a. A 6-month-old infant with hypospadias and cryptorchidism b. A 2-year-old child with leukemia c. A 4-year-old child with hip dysplasia d. A 9-month-old child with surgically corrected cleft-lip

6-month-old infant with hypospadias and cryptorchidism

A nurse is reviewing the medical records of several children who have undergone lead screening. The nurse would identify the child with which lead level as requiring no further action? a. 8 mcg/dL b. 14 mcg/dL c. 20 mcg/dL d. 26 mcg/dL

8 mcg/dL

The nurse is caring for a pediatric client who is scheduled for the surgical removal of a Wilms tumor. Which is contraindicated in the client's care? Intravenous fluids Abdominal palpation Foley catheter placement Supine positioning

Abdominal palpation

Wilm's tumor is suspected in a 5-year-old child. Which action would be avoided? a. Abdominal palpation b. Fiber intake c. Aspirin administration d. Rectal suppository use

Abdominal palpation

Hematopoietic stem cell transplant is often required for what types of patients? 1. Acute Lymphoblastic Leukemia 2. Acute Myelogenous Leukemia 3. Neuroblastoma 4. Rhabdomyosarcoma

Acute Myelogenous Leukemia

When reviewing information about the incidence of the various types of childhood cancer, nursing students demonstrate understanding of the information when they identify which type as having the highest incidence?

Acute lymphocytic (lymphoblastic) leukemia

A young school-age child who is being treated for cancer has constipation and loss of appetite. What nursing interventions should the nurse suggest to the family? Choose all that apply. a. Increase gross motor activities such as family walks. b. Provide adequate private time in the bathroom. c. Use a rectal suppository at the same time each day. d. Add high-fiber snacks such as popcorn and apples to the diet.

Add high-fiber snacks such as popcorn and apples to the diet. Provide adequate private time in the bathroom. Increase gross motor activities such as family walks.

The nurse is caring for a 6-year-old boy with an abdominal neuroblastoma prior to having a magnetic resonance imaging (MRI) scan without contrast done. Which intervention would the nurse expect to perform? a. Administering a sedative as ordered to keep the child still b. Encouraging fluid intake to increase radionuclide uptake c. Applying EMLA to the injection site prior to inserting the IV d. Advising the physician that the child is allergic to shellfish

Administering a sedative as ordered to keep the child still

A child is to receive radiation therapy this morning. The nurse would expect to see which type of drug prescribed to this child?

Antiemetic

The nurse is preparing to send a child with cancer for a radiation treatment. Which medication should the nurse provide to premedicate the child for this procedure? 1. Analgesic 2. Antiemetic 3. Antipyretic 4. Antineoplastic

Antiemetic

The nurse is providing preoperative care for a 7-year-old boy with a brain tumor and his parents. Which intervention is priority?

Assessing the child's level of consciousness The priority intervention is to monitor for increases in intracranial pressure because brain tumors may block cerebral fluid flow or cause edema in the brain. A change in the level of consciousness is just one of several subtle changes that can occur indicating a change in intracranial pressure. Lower priority interventions include providing a tour of the ICU to prepare the child and parents for after the surgery, and educating the child and parents about shunts.

A 4-year-old child diagnosed with Wilms tumor is admitted for surgery. What information would be most important for the nurse to include in the child's preoperative plan of care?

Avoiding further abdominal palpation

A patient has a rhabdomyosarcoma in their orbit. How would they be treated? 1. Surgery 2. Chemotherapy 3. Acetaminophen 4. Biopsy

Biopsy

A group of nursing students are studying information about childhood cancers in preparation for a class examination. They are reviewing how childhood cancers differ from adult cancers. The group demonstrates understanding of the information when they identify what location as an unlikely site for childhood cancer? a. brain b. lungs c. blood d. bladder

Bladder

The nurse is admitting to an examination room a child with the diagnosis of "probable acute lymphoblastic leukemia." What will confirm this diagnosis? a. History of leukemia in twin b. Bone marrow aspiration c. Complete white blood count d. Lethargy, bruising, and pallor

Bone Marrow aspiration

In addition to the child's history, symptoms, and blood studies, what information helps to confirm the diagnosis of leukemia?

Bone marrow aspiration In addition to the history, symptoms, and laboratory blood studies, a bone marrow aspiration must be done to confirm the diagnosis of leukemia. Genetic studies are done for hereditary diseases such as sickle cell anemia and hemophilia. The modified Jones criteria are used as a guide to note the manifestations of rheumatic fever, and chest x-rays help in diagnosing congestive heart failure.

The nurse is providing care to a child with leukemia. When assessing the child, which signs and symptoms would the nurse likely find? Select all that apply. 1. Bruising 2. Anorexia 3. Sore throat 4. Lymphadenopathy 5. Increased platelet count 6. Increased hemoglobin

Bruising Anorexia Sore throat Lymphadenopathy

Which of the following are diagnosis test for acute Lymphoblastic leukemia? (select all that apply) 1. CBC count 2. lumbar test 3. flow cytometry 4. CT/ MRI scan

CBC count lumbar test flow cytometry

Changes in behavior or personality, headache, irritability, dizziness, persistent nausea or vomiting, seizures, gait changes, lethargy, or altered level of consciousness may indicate what in a patient with acute Lymphoblastic leukemia?

CNS infiltration with leukemic cells

Which mechanism is central to cancers in children? a. Genetics b. Environment c. Cellular growth d. Race

Cellular growth

Which of the following findings of a patient with acute Lymphoblastic leukemia do you report to the doctor immediately? 1. Changes in behavior or personality 2. headache and/or dizziness 3. altered level of consciousness 4. gums bleeding

Changes in behavior or personality headache and/or dizziness altered level of consciousness

A patient is diagnosed with osteosarcoma. Before surgery, what medication is given to the patient to reduce the size of the tumor?

Chemotherapy (it's always given before and after surgery)

Treatment for CNS prophylaxis are the following?

Chemotherapy through an intrathecal catheter

The nurse is assessing a 10-year-old girl with acute lymphoblastic leukemia. What information would lead the nurse to suspect that the cancer has infiltrated the central nervous system?

Child reports of facial palsy and vision problems

Treatment in maintenance stage are the following?

Low doses of 6-mercaptopurine and methotrexate

A child is diagnosed with rhabdomyosarcoma involving the neck. When assessing the child, what would the nurse anticipate? 1. Dysphagia 2. Hoarseness 3. Visible and palpable mass in the neck. 4. Anorexia

Dysphagia Hoarseness Visible and palpable mass in the neck.

Which test result would the nurse least likely expect to find in a child diagnosed with Wilms tumor? 1. IVP (intravenous pyelogram) 2. Abdominal ultrasound 3. Elevated homovanillic acid (HVA) with 24-hour urine collection 4. CT/MRI scan

Elevated homovanillic acid (HVA) with 24-hour urine collection

The pediatric nurse examines the radiographs of a client that show that there are lesions on the bone. This finding is indicative of: a. Wilm's tumor b. Ewing Sarcoma c. Osteosarcoma d. Leukemia

Ewing Sacroma

Common signs and symptoms of Acute Lymphoblastic Leukemia

Fever, listlessness, Pallor, Abdominal pain, headache

The nurse is caring for a child with leukemia. Which nursing intervention would be the highest priority for this child?

Following guidelines for protective isolation

The nurse is caring for a 4-year-old boy following surgical removal of a stage I neuroblastoma. Which intervention is most appropriate for this child?

Giving medications as ordered via least invasive route Giving medications as ordered using the least invasive route is a postsurgery intervention focused on providing atraumatic care and is appropriate for this child. Since the child has a stage I tumor, it can be treated by surgical removal, and does not require chemotherapy or radiation therapy. Applying aloe vera lotion is good skin care following radiation therapy. Administering antiemetics and maintaining isolation are interventions used to treat side effects of chemotherapy.

Treatment in consolidation (Intensification) stage are the following?

High-dose methotrexate and 6-mercaptopurine

A child is scheduled for chemotherapy as treatment for leukemia. As the nurse is collaborating with another collegue, it is asked in which phase of the chemotherapy treatment the client is. The nurse is most correct to outline the phases as which? Place the phases in the order in which the nurse would describe from first to last.

Induction Consolidation (Intensification) Maintenance

A child with ALL is beginning treatment with methotrexate in an attempt to eradicate the leukemic cells. The stage of therapy represents the:

Induction stage An induction stage is the first attempt at eradicating the leukemic cells to induce or achieve a complete remission.

A school-aged child with cancer is receiving chemotherapy. Which nursing action would best promote the oral comfort of a child receiving chemotherapy?

Keeping the child's lips moist with Vaseline to prohibit cracking

The nurse is caring for a 14-year-old boy with an osteosarcoma. Which communication technique would be least effective for him?

Letting him choose juice or soda to take pills

A child undergoing chemotherapy for leukemia is receiving methotrexate as part of maintenance therapy. What would the nurse expect to be prescribed to assist in counteracting the effects of this drug? a. Leucovorin b. Vincristine c. Cisplatin d. Prednisone

Leucovorin

What is a well-defined risk management technique that the nurse can teach children and parents to prevent cancer?

Limit sun exposure throughout childhood and adolescence

When providing care for a child immediately after a bone marrow aspiration, which nursing action is priority?

Monitor the site dressing and vital signs

A patient states that they are having pain, epistaxis, and nasal congestion? Where is the rhabdomyosarcoma located? 1. Orbit 2. Nasopharynx 3. Neck 4. Sinuses

Nasopharynx

A nurse is assessing a patient with dysphagia and hoarseness. Where is the rhabdomyosarcoma located? 1. Orbit 2. Nasopharynx 3. Neck 4. Sinuses

Neck

A hospice nurse is providing at-home care to a child with end-stage cancer. The nurse is developing a plan of care to manage the child's pain. Which medications will the nurse likely include?

Opioids

Treatment in induction stage are the following?

Oral steroids, vincristine through an intravenous line, IM L-asparginase

A nurse is assessing a patient with proptosis. Where is the rhabdomyosarcoma located? 1. Orbit 2. Nasopharynx 3. Neck 4. Sinuses

Orbit

Which of the following disorders peak in adolescents? a. Acute Myelogenous Leukemia b. Osteosarcoma c. Acute Lymphoblastic Leukemia d. Ewing's sarcoma

Osteosarcoma, Ewing's sarcoma, Acute Myelogenous Leukemia

A nurse is providing care to a toddler with Wilm's tumor (nephroblastoma) and is being evaluated. Which nursing action would be most important?

Placing a "no abdominal palpation" sign above the child's bed

What is the priority action the nurse should take when caring for a child newly diagnosed with Wilms tumor (nephroblastoma)? a. Protect the abdomen from manipulation. b. Control acute pain. c. Assess for constipation. d. Obtain a catheterized urine specimen.

Protect the abdomen from manipulation.

A child with ALL is receiving methotrexate for therapy. Which nursing diagnosis would best apply to him during therapy? 1. Risk for impaired skin integrity related to oral ulcerations associated with chemotherapy 2. Risk for impaired mobility related to depressant effects of methotrexate 3. Excess fluid volume related to effect of methotrexate on aldosterone secretion 4. Risk for self-directed violence related to effect of methotrexate on central nervous system

Risk for impaired skin integrity related to oral ulcerations associated with chemotherapy

The nurse is assessing an adolescent with suspected osteosarcoma. What would the nurse be least likely to assess?

Severe bone pain

The nurse is caring for a 6-year-old girl with leukemia who is having an oncological emergency. Which signs and symptoms would indicate hyperleukocytosis? a. Respiratory distress and poor perfusion b. Wheezing and diminished breath sounds c. Bradycardia and distinct S1 and S2 sounds d. Tachycardia and respiratory distress

Tachycardia and respiratory distress

What is consolidation (Intensification)?

intensive treatment after remission is achieved to eradicate residual leukemia cells (to maintain remission and prevent disease)

what is the difference in the induction phase between AML and ALL?

The induction phase of AML requires intense bone marrow suppression and prolonged hospitalization because AML is less responsive to treatment than ALL

The most common sites for Ewing Sarcoma are?

pelvis, chest wall, vertebrae, and long bone diaphyses (midshaft).

The nurse preparing clients for diagnostic testing for cancer knows that the following test is used to differentiate a neuroblastoma from other tumors: a. Serum chemistries b. Urine catecholamines metabolites homovanillic acid (HVA) and vanillylmandelic acid (VMA) c. Complete blood count (CBC) with differential d. Urinalysis

Urine catecholamines metabolites homovanillic acid (HVA) and vanillylmandelic acid (VMA)

Clinical Manifestations in neuroblastoma

abdominal mass, weight loss, anorexia, raccoon eyes

The toddler with a cancer diagnosis is seen for a well-child checkup. Which health maintenance activity will the nurse exclude?

administering MMR vaccine

If a patient has a rhabdomyosarcoma tumor in their neck, what is the first thing you assess?

airway

What is the confirmation test for acute Lymphoblastic leukemia?

bone marrow biospy

Signs and symptoms of osterosarcoma

bone pain and fracture, limping, limited ROM,

A 5-year-old child is at the pediatric clinic for a well-child visit. Which symptom alerts the health care provider that this child might have acute lymphocytic leukemia?

lethargy, bruises, and lymphadenopathy

The most common sites for osteosarcoma are?

long bones, particularly the proximal humerus, proximal tibia, and distal femur

The nurse is providing care to a child and is to collect a 24-hour urine specimen for catecholamines. The nurse integrates knowledge of this testing as indicative of: a. neuroblastoma. b. leukemia. c. Hodgkin disease. d. osteosarcoma.

neuroblastoma.

The nurse is completing the health history of a 6-month-old infant with retinoblastoma with the child's parents. Which symptom should the nurse expect that the parents have observed? a. One pupil appears white. b. The infant tugs and pulls at one ear. c. The infant's eye appears to be protruding. d. The infant always keeps her eyes tightly closed.

one pupil appears white

What is the confirmation test for rhabdomyosarcoma?

open biopsy

Common signs and symptoms of Acute Myelogenous Leukemia

recurrent infections, fever, or fatigue

What is CNS prophylactic therapy?

reduces risk of development of CNS disease

A patient with acute Lymphoblastic leukemia states that they have been having persistent nausea and vomiting for the pass few days. Which intervention is priority? 1. give them antiemetics 2. report findings to doctor 3. assess vital signs 4. tell them that is normal

report findings to doctor

A child comes into the doctor's office with strabismus. What disorder could this be? 1. leukemia 2. retinoblastoma 3. Wilm's tumor 4. Ewing sarcoma

retinoblastoma

What is the maintenance stage?

serves to maintain remission phase by eliminating all residual leukemia cells

A nurse is teaching a school-aged child with iron-deficiency anemia and her parents about dietary measures to increase iron intake. The nurse determines that the teaching was successful when they state which food is high in iron? Select all that apply.

• Eggs • Fortified cereal • Green leafy vegetables

Parents ask why their child just diagnosed with leukemia needs a "spinal tap." Which is the best response by the nurse? a. "It will help rule out a second malignancy." b. "Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system." c. "The spinal tap will help relieve pressure and headache for your child." d. "A sample of cerebrospinal fluid is needed to check for possible central nervous system infection."

"Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system."

Parents bring their daughter to the health care facility for evaluation. They report that lately the child seems rather pale and really tired. What would the nurse most likely find with further assessment if the child has acute lymphoblastic leukemia (ALL)? Select all that apply. Bleeding from the oral mucous membranes Headache Painless cervical-lymphadenopathy Low-grade fever

Bleeding from the oral mucous membranes Headache Painless cervical-lymphadenopathy Low-grade fever

The nurse is preparing a discharge teaching plan for the parents of an 8-year-old girl with leukemia. Which instruction would be the priority?

Calling the doctor if the child gets a sore throat

A teenage girl asks why chemotherapy causes hair loss. Which response by the nurse is accurate? a. Circulation to the head causes large doses of chemotherapy to reach the scalp. b. Hair is not a living tissue, and it is easily damaged by chemotherapy. c. Chemotherapy affects cancer cells and normal cells that multiply rapidly. d. Hair is exposed to the sun, which increases sensitivity to chemotherapy.

Chemotherapy affects cancer cells and normal cells that multiply rapidly. Chemotherapy is cytotoxic to rapidly proliferating cells---malignant or normal. Normal cells that turn over rapidly include those of bone marrow, hair, and mucous membranes. The other responses are not accurate.

A nursing student compares and contrasts childhood and adult cancers. Which statement does so accurately?

Children's cancers, unlike those of adults, often are detected accidentally, not through screening. Children's cancers are often found during a routine checkup, following an injury, or when symptoms appear---not through screening procedures or other specific detection practices. A very small percentage of children may be followed closely because they are known to be at high risk genetically. Most children's cancers are highly responsive to therapy. Few prevention strategies are available for children, although many are known to be effective for adults. Several lifestyle and environmental influences regarding children's cancers are suspect, but few have been scientifically documented. The reverse is true in the adult population.

A child diagnosed with stage IV neuroblastoma has undergone abdominal surgery to remove the tumor. He is now receiving chemotherapy. Which nursing diagnosis would be most important?

Grieving related to advanced disease and poor prognosis

A preschooler who received chemotherapy in the pediatric oncology outpatient department 1 week ago now has a temperature of 101.5°F (38.6°C). Which is the most appropriate response by the nurse?

Have the parent bring the child to the pediatric oncology clinic as soon as possible. The preschooler is considered immune suppressed following recent chemotherapy. A fever can mean sepsis, which would require immediate investigation of blood and other body fluids to identify the organism, plus prompt treatment with an IV antibiotic. This can be accomplished only by seeing the pediatric oncologist and is likely to result in hospitalization.

The nurse identifies the nursing diagnosis of risk for infection related to chemotherapy-induced immunosuppression. What would the nurse include in the teaching plan for the child and parents about reducing the child's risk? Select all that apply.

Having the child sleep in a single bed and room Encouraging frequent, thorough handwashing To reduce the risk of infection, the nurse should teach the child and parents about minimizing the child's exposure to potentially infectious situations. The nurse should encourage the parents to arrange for the child to sleep in a single bed and room and, if possible, avoid close contact with other family members who may be developing upper respiratory tract infections. Thorough and frequent handwashing, especially after using the bathroom and before eating, is essential. A high-calorie, high-protein diet helps to rebuild white blood cells and should be encouraged. If possible, the child's exposure to large crowds and visitors should be limited because of the increased risk of infection from these individuals. Fresh flowers and plants should be avoided because they could harbor mold spores.

A 15-year-old boy has been diagnosed with an osteogenic sarcoma of the distal femur. He also demonstrates a chronic cough, dyspnea, and chest pain, along with chronic leg pain. Based on these findings, the nurse should suspect metastasis to which body area?

Lungs

The nurse is caring for a 16-year-old boy with acute myelogenous leukemia who is having chemotherapy and who has incomplete records for varicella zoster immunization. Which is the priority nursing diagnosis?

Risk for infection related to neutropenia and immunosuppression.

Which test result would the nurse most likely expect to find in a child diagnosed with neuroblastoma? 1. IVP (intravenous pyelogram)- 2. Abdominal ultrasound- 3. Elevated homovanillic acid (HVA) with 24-hour urine collection- 4. CT/MRI scan-

elevated homovanillic acid (HVA) with 24-hour urine collection-