PEDS Quiz 9

The nurse is developing a plan of care for a child being admitted to the hospital who is immunosuppressed and who will be placed on neutropenic precautions. With regard to neutropenic precautions, which intervention is incorrect?

admitting the client to a semiprivate room

Stroke

A stroke can happen if sickle cells get stuck in a blood vessel and clog blood flow to the brain. About 10% of children with SCD will have a symptomatic stroke. Stroke can cause learning problems and lifelong disabilities. Prevention: Children who are at risk for stroke can be identified using a special type of exam called, transcranial Doppler ultrasound (TCD). If the child is found to have an abnormal TCD, a doctor might recommend frequent blood transfusions to help prevent a stroke. People who have frequent blood transfusions must be watched closely because there are serious side effects. For example, too much iron can build up in the body, causing life-threatening damage to the organs.

Morphine sulfate

An opioid analgesic that is used to treat the severe pain of a vaso-occlusive crisis.

A child with acute lymphoblastic leukemia (ALL) who is receiving chemotherapy has the following lab results: WBC 9,000, Hemoglobin 12, and Platelets 20,000. When planning this child's care, which risk should the nurse consider most significant?

Hemorrhage

Which of the following are characteristics of hemophilia or recommended treatment for hemophilia? (Select all that apply).

In hemophilia, there is a deficiency of one of the factors necessary for blood coagulation. An abnormal clotting pattern occurs, resulting in an ineffective clot. Hemophilia is inherited as an x-linked recessive disorder. The mother passes this disorder to her male children. When a female inherits the gene from her father, she has a 50% chance of transmitting it to her son. Bleeding and bruising easily. Gum bleeding occurs. Joint hemorrhages or hemarthrosis. Early signs are stiffness, tingling or aching in the joint, and inability to move the joint. Other symptoms are warmth, redness, swelling, and pain. Intracranial bleeding is the major cause of death in children with hemophilia.

Chemotherapy is one of the therapeutic modalities for pediatric cancer. This treatment is contraindicated in which of the following conditions? (Select all-that-apply)

Infection Recent surgery Impaired renal and hepatic function Pregnancy

A nurse is caring for a child with sickle cell anemia who is suffering from a vaso-occlusive crisis. Which of the following interventions should the nurse employ to effectively monitor and to help improve the blood flow to the child's tissues?

Monitor vital signs carefully. Assess pulses for rate, rhythm, and volume. Note hypotension; rapid, weak, thready pulse; and tachypnea with shallow respirations. Assess skin for coolness, pallor, cyanosis, diaphoresis, and delayed capillary refill. Note changes in LOC; reports of headaches, dizziness; development of sensory or motor deficits, such as hemiparesis or paralysis; and seizure activity. Maintain adequate fluid intake. Monitor urine output. Maintain environmental temperature and body warmth without overheating. Avoid hypothermia. Administer oxygen to saturate circulating hemoglobin and increase the effectiveness of blood that is reaching the ischemic tissues.

A child with leukemia is being discharged after beginning chemotherapy. Which of the following instructions should the nurse include when teaching the parents of this child?

Notify the provider if the child's temperature exceeds 101 F (38 Avoid fresh vegetables that are not cooked or peeled. do not take the child's temperature by the rectal route live, attenuated vaccines should not be administered to children with weakened immune systems

Splenic sequestration

Splenic sequestration happens when a large number of sickle cells get trapped in the spleen and cause it to suddenly get large. Symptoms include sudden weakness, pale lips, fast breathing, extreme thirst, abdominal (belly) pain on the left side of body, and fast heartbeat. When the spleen doesn't work well, a person is more likely to have serious, life-threatening infections with certain types of bacteria. If splenic sequestration happens suddenly, it can be a life-threatening emergency. Parents of a child with sickle cell disease (SCD) should learn how to feel and measure the size of their child's spleen and seek help if the spleen is enlarged.

Hand-foot syndrome

Swelling in the hands and feet usually is the first symptom of SCD. This swelling, often along with a fever, is caused by the sickle cells getting stuck in the blood vessels and blocking the flow of blood in and out of the hands and feet. Treatment: The most common treatments for swelling in the hands and the feet are pain medicine and an increase in fluids, such as water.

A child has been diagnosed with sickle cell disease. The parents are unsure how their child contracted the disease. The nurse should explain that

The mother and the father of the child have the sickle cell trait

Acute chest syndrome

This can be life-threatening and should be treated in a hospital. Symptoms and signs are similar to pneumonia. Signs and symptoms include chest pain, coughing, difficulty breathing, and fever. Prevention: Children with severe SCD can take a medicine called hydroxyurea to help prevent acute chest syndrome. People taking hydroxyurea must be watched closely because the medicine can cause serious side effects, including a low white blood cell count which increases the risk of dangerous some types of infections. A person who is on bed rest or has recently had surgery can use an incentive spirometer, also called "blow bottle," to help prevent acute chest syndrome. Treatment: Depending on the cause, treatment might include oxygen, medicine to treat an infection, medicine to open up airways to improve air, and blood transfusions.

Anemia

This is a very common complication of SCD. With SCD, the red blood cells die early. This means there are not enough healthy red blood cells to carry oxygen throughout the body. When this happens, a person might have: Tiredness; Irritability; Dizziness and lightheadedness; A fast heart rate; Difficulty breathing; Pale skin color; Jaundice (yellow color to the skin and whites of the eyes); Slow growth; and Delayed puberty

Deferoxamine mesylate (Desferal)

This medication helps prevent damage to the liver and bone marrow from iron deposition by promoting renal and hepatic excretion in urine and bile in feces. It readily chelates iron from ferritin and hemosiderin but not from transferrin. It does not affect iron in the cytochromes or hemoglobin. This agent is most effective when administered by continuous infusion. It gives urine a red discoloration.

Hydroxyurea

This medication increases fetal hemoglobin (HbF) production and slightly raises the total hemoglobin concentration in the body. Fetal hemoglobin reduces the chance that red blood cells will sickle in a person who has sickle cell disease. So increased production of HbF can reduce the occurrence of sickling-related complications such as vaso-occlusive crisis or acute chest syndrome.

Folic acid

This medication is necessary for erythropoiesis (formation of new red blood cells). Supplemental folic acid replenishes depleted folate stores secondary to hemolysis.

Chronic conditions causing anemia in children include sickle cell disease, thalassemia major, cancer, aplastic anemia, folate deficiency, inflammatory bowel disease, infection, chronic renal disease, and liver disease. True or false?

True

A child with hemophilia plans on participating in a bicycling club. The nurse should recommend the child

Wear kneepads, elbow pads, and a helmet while bicycling.

The pediatric nurse understands that the most common cancer found in children is

acute lymphocytic leukemia

The nurse is caring for a child who is in sickle cell anemic crisis and has severe pain. The most effective nursing intervention for this child should be

administering pain medication

Which nursing diagnosis is highest-priority for a 3-year-old child undergoing chemotherapy and experiencing nausea and vomiting?

deficient fluid volume

Treshaun, age 5, has sickle cell anemia. His mother asks how he can avoid a sickle cell pain crisis. Which of the following can trigger a sickle cell crisis?

dehydration infection, such as the cold or flu low oxygen levels from difficult exercise, flying, or high altitude medical procedures or surgery strong emotions, such as anger or depression getting cold or going from warm to cold quickly stressful situations such as bullying at school, moving to a new house, parents divorcing, or death of a family member

The nurse is teaching parents how to prevent a sickle cell crisis in the child with sickle cell disease. The nurse should explain that precipitating factors contributing to a sickle cell crisis include

fever dehydration altitude

The goal of chemotherapy is to target specific aspects of the cell cycle to maximize tumor cell death and minimize healthy cell damage. True or false?

true

A 15-year-old has been admitted to the hospital with the diagnosis of acute lymphocytic leukemia. Which of the following signs and symptoms require the most immediate nursing intervention?

Fever and petechiae

The nurse should expect to administer this drug for a sickle cell pain crisis

morphine sulfate

A child undergoing chemotherapy treatment has the following laboratory values: Absolute neutrophil count of 400 mm3; Hematocrit (HCT) 32%; Platelet Count 150,000 per microliter; Serum Potassium 4.5 mmol/L. The pediatric nurse correctly determines that the child is at risk for:

infection

When caring for the child with leukemia who is at risk for bleeding, which of the following measures should be avoided?

performing a rectal examination

You are the nurse in charge on a pediatric unit. A child with sickle cell disease, in splenic sequestration crisis, is being admitted. You should assign this child to a

private room

A client with hemophilia has a very swollen knee after falling from riding a bicycle. Which of the following should be the first nursing action?

Apply an ice pack and compression dressings to the kn

When assessing a child who has a neuroblastoma of the adrenal gland, which of the following findings indicate to the nurse that the child has developed metastasis from the primary site? (Select all that apply.)

Bone pain Varying degrees of paralysis Hepatomegaly

Which of the following are characteristics of hemophilia?

Easy bruising occurs. Gum bleeding occurs. It is a hereditary bleeding disorder. The blood does not clot properly, due to defects or the absence of clotting factors in the blood.

A nurse is developing a plan of care for 5-year-old child with a diagnosis of sickle cell anemia and formulates the following nursing diagnoses. The nurse should select which nursing diagnosis as the priority?

Deficient Fluid Volume

Scenario: A 3-year-old child with Wilms' tumor of the right kidney is admitted to the pediatric oncology unit. He is to undergo a course of chemotherapy, followed by radiation treatments to shrink the tumor before surgically removing it, along with the kidney and the adjacent adrenal gland. The child will receive additional radiation after surgery. When completing the child's admission assessment, which of the following components of the abdominal assessment should the nurse avoid?

Palpation

A 4-year-old-child has been admitted with a diagnosis of sickle cell anemia. The nurse should expect to see which of the following lab results for this child?

Serum hemoglobin 7.7 g/dL

Penicillin VK

Sickle cell disease patients are particularly vulnerable to infection. Children with sickle cell disease have a 20- to 100-fold higher rate of incidence of Streptococcus pneumoniae than the general population. This medication is given prophylactically on a daily basis throughout childhood to help prevent this infection from occurring.