Prep U Ch 46

The child's mother states, "It seems like he catches every bug that comes along." The child has no hair on his head. The child's mother states that she often has to repeat herself because he can't hear very well. The child reports feeling nauseated.

The child has been diagnosed with cancer and is being treated with chemotherapy. Which findings are common side effects of this type of treatment? Select all that apply. The child's teeth are enlarged. The child reports feeling nauseated. The child's mother states, "It seems like he catches every bug that comes along." The child's mother states that she often has to repeat herself because he can't hear very well. The child has no hair on his head.

Avoiding further abdominal palpation

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? Preparing the child for amputation Performing dressing changes to the affected area Avoiding further abdominal palpation Administering analgesics for pain

Prepare to administer factor replacement medication

A child diagnosed with hemophilia presents with warm, swollen, painful joints. Which action will the nurse take first? Prepare to administer factor replacement medication Document the presence of hemarthrosis in the client's chart Notify the client's primary health care provider Assess the client's urine and stool for blood

to decrease fever produced from the medication

A child diagnosed with idiopathic thrombocytopenic purpura (ITP) is scheduled to receive an infusion of intravenous immunoglobulin (IVIG) due to low platelet counts. Prior to the infusion, the nurse administers acetaminophen to the child. The nurse would explain to the parents that acetaminophen is administered to obtain which expected outcome? to decrease fever produced from the medication to prevent chills from developing to reduce any pain at infusion site to relax the child during drug infusion

Administer intravenous fluids as prescribed.

A child is hospitalized with a diagnosis of sickle cell crisis. The nurse has completed an assessment with the above findings. Which intervention is the nurse's priority in providing care? Provide pain medication. Administer blood transfusion as prescribed. Administer intravenous fluids as prescribed. Maintain the client in NPO status.

The child has mild to moderate iron deficiency.

A child with iron-deficiency anemia is prescribed ferrous fumarate, 3 mg/kg/day in two divided doses. What does this prescription indicate to the nurse? The child requires a prophylactic dose of iron. The child is being prepared for packed red blood cell administration. The child has mild to moderate iron deficiency. The child has severe iron deficiency.

Administer acetaminophen as needed.

A parent calls the pediatric oncology clinic about the child having headaches after chemotherapy. What is the nurse's best advice? Administer ibuprofen every 6 hours. Administer acetaminophen as needed. Use an ice pack on the child's head. Administer oral hydrocodone as needed.

Urine catecholamine metabolites, homovanillic acid (HVA), and vanillylmandelic acid (VMA)

The nurse is preparing clients for diagnostic testing for cancer. Which test is used to differentiate a neuroblastoma from other tumors? Complete blood count (CBC) with differential Urinalysis Urine catecholamine metabolites, homovanillic acid (HVA), and vanillylmandelic acid (VMA) Serum chemistries

Provide nutritious snacks such as a milkshake. Suggest eating prior to chemotherapy. Encourage the child to pick foods that are appetizing. Maintain pleasant family meal times even if child is not hungry.

The nurse is teaching parents about help improving their child's nutritional status while on chemotherapy. What information would be included in the teaching? Select all that apply. Suggest eating prior to chemotherapy. Provide nutritious snacks such as a milkshake. Maintain pleasant family meal times even if child is not hungry. Offer larger portions at meal time to encourage eating. Encourage the child to pick foods that are appetizing. Use honey to improve taste of cereals.

Body appearance changes very little.

What is one advantage of an implanted port (central venous access device) that the nurse will explain to an adolescent? No tunneling is needed when the port is inserted. No special procedure is necessary for removal. Flushing of the device is not necessary. Body appearance changes very little.

Protect the abdomen from manipulation.

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

vitamin B12 injections

While assessing an adolescent, the nurse notes pallor and a beefy red tongue. Upon questioning, the adolescent reports eating a vegetarian diet to help with weight loss. Which health care provider prescription will the nurse anticipate? vitamin B12 injections hydroxyurea orally ferrous sulfate daily folic acid supplement

hemoglobin electrophoresis

A nurse is caring for a newborn whose screening test result indicates the possibility of sickle cell anemia (SCA) or sickle cell trait. The nurse would expect the test result to be confirmed by which lab tests? reticulocyte count erythrocyte sedimentation rate peripheral blood smear hemoglobin electrophoresis

compression

A nurse is providing care to a child with hemophilia who is experiencing muscle and joint involvement related to the bleeding. Which would the nurse include as an adjunctive measure to control bleeding? lowering extremities heat compression exercise

red meat, eggs, oatmeal, and dried fruit

The nurse develops a meal plan for a child with iron-deficiency anemia. Which meal would the nurse teach the parent has the highest amount of iron? chicken, corn, brown rice, and oranges red meat, eggs, oatmeal, and dried fruit pork, broccoli, white rice, and strawberries tuna salad with eggs, whole wheat crackers, and blueberries

Observation reveals nystagmus and head tilt.

The nurse is assessing a 3-year-old boy whose mother reports that he is listless and has been having trouble swallowing. Which finding suggests the child may have a brain tumor? Observation reveals nystagmus and head tilt. Examination shows temperature of 101.4° F (38.6°C) and headache. Observation reveals a cough and labored breathing. Vital signs show blood pressure measures 120/80 mm Hg.

A 15-year-old adolescent who has heavy menstrual periods

The nurse is assessing children in an ambulatory clinic. Which child would be most likely to have iron-deficiency anemia? An 8-year-old child who carries lunch to school A 3-month-old infant who is totally breastfed A 7-month-old infant who has started table food A 15-year-old adolescent who has heavy menstrual periods

Ensure neutropenic precautions are in place.

The nurse is caring for a child who had a stem cell transplant and is being monitored for engraftment. Which nursing action is priority? Encourage therapeutic play activities. Remind parents to contact the child's school. Monitor daily complete blood count (CBC). Ensure neutropenic precautions are in place.

"You may feel pressure on your hip during the procedure."

The nurse is explaining the procedure of bone marrow aspiration to a 6-year-old child with leukemia. What explanation would be best to give to the child? "You will need to lie still afterward to prevent a headache." "You may feel pressure on your hip during the procedure." "The numbing medicine on your skin will keep you from having pain." "You will have to lie on your back and hold your breath."

"My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C."

The nurse is reinforcing teaching with a group of caregivers of children diagnosed with iron-deficiency anemia. One of the caregivers tells the group, "I give my child ferrous sulfate." Which statement made by the caregivers is correct regarding giving ferrous sulfate? "My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C." "I always give the ferrous sulfate with meals." "When I give my son ferrous sulfate I know he also needs potassium supplements." "We watch closely for any diarrhea since that usually happens when he takes ferrous sulfate."

11.0 to 13.0 seconds

The nurse is reviewing the results of a clotting study for a healthy 6-year-old. What would the nurse document as a normal prothrombin finding? 16.0 to 18.0 seconds 11.0 to 13.0 seconds 6.0 to 9.0 seconds 21.0 to 35.0 seconds

Monitor the site dressing and vital signs.

When providing care for a child immediately after a bone marrow aspiration, which nursing action is priority? Educate the family on proper handwashing. Monitor the site dressing and vital signs. Allow the child to play with a doll and syringe. Evaluate pain and administer medication.

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

A nurse is providing care to a toddler with nephroblastoma and is being evaluated. Which nursing action would be most important? Preventing weight-bearing activities Restricting the child's visitors Ensuring that the child be allowed nothing by mouth Preparing the child for chemotherapy Placing a "no abdominal palpation" sign above the child's bed

Children's cancers, unlike those of adults, often are detected accidentally, not through screening.

A nursing student compares and contrasts childhood and adult cancers. Which statement does so accurately? Little is known regarding cancer prevention in adults, although much prevention information is available for children. Children's cancers, unlike those of adults, often are detected accidentally, not through screening. Environmental and lifestyle influences in children are strong, unlike those in adults. Adult cancers are more responsive to treatment than are those in children.

Administer broad-spectrum antibiotics intravenously.

A client with cancer is diagnosed with typhlitis. Which emergency intervention would the nurse perform? Maintain fluid restriction to below maintenance levels. Monitor serum sodium levels. Administer broad-spectrum antibiotics intravenously. Administer diuretics.

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

Parents ask why their child just diagnosed with leukemia needs a "spinal tap." Which is the best response by the nurse? "The spinal tap will help relieve pressure and headache for your child." "It will help rule out a second malignancy." "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."

Restrict all visits from other children. Provide sterilized age-appropriate play materials.

The nurse is caring for a school-age child recovering from an allogeneic stem cell transplant. What nursing action best ensures the child does not develop an infection after the transplant? Select all that apply. Send for total body irradiation immediately after the transplant. Provide sterilized age-appropriate play materials. Restrict all visits from other children. Arrange time for studying while in the hospital. Encourage eating raw vegetables for each meal after the procedure.

giving ferrous sulfate with orange juice between meals

The nurse is providing care for a 13-year-old child diagnosed with iron-deficiency anemia. The client's current hemoglobin level is 11 g/dL (110 g/L). Which intervention will the nurse anticipate including in the client's care? increasing the daily intake of fresh fruits and vegetables providing a high dose of intravenous immunoglobulin weekly giving ferrous sulfate with orange juice between meals packed red blood cell transfusions

Ewing sarcoma

The pediatric nurse reviews the radiographs of a child and observes that there are lesions on the bone. The nurse interprets this finding as suggesting which condition? neuroblastoma non-Hodgkin lymphoma Ewing sarcoma Hodgkin disease

Bone marrow stem cell transplant

A nurse is providing care to a child with thalassemia major. The nurse understands that cure of the disorder is achieved with which treatment? Splenectomy Oral iron chelating agents Bone marrow stem cell transplant Hypertransfusion therapy

"I mix ferrous sulfate with milk in a bottle."

The nurse is caring for a toddler taking ferrous sulfate for severe iron-deficiency anemia. Which report by the parent is most concerning? "I brush my child's teeth once every day." "My child's stools are darker than usual." "I mix ferrous sulfate with milk in a bottle." "My child takes ferrous sulfate after meals."

Lungs

A 15-year-old boy has been diagnosed with an osteosarcoma 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? Rib cage Lungs Heart Brain

Call it a tumor of muscle tissue

How can the nurse most simply describe for distressed parents a rhabdomyosarcoma that has been found in their 5-year-old? Indicate that the more commonly used name is Hodgkin lymphoma Explain that it develops in nerves outside the brain and spinal cord Call it a tumor of muscle tissue Describe it as a bone tumor

Christmas factor

Individuals with hemophilia B have a deficiency in factor IX, which can cause excessive blood loss. What is another name for this clotting factor? Christmas factor Proconvertin Antihemophilic factor Stuart factor

Leukemia

Nursing students are reviewing information about childhood cancers. They demonstrate understanding of the information when they identify what as the most frequent type? Wilms tumor Brain stem tumor Non-Hodgkin lymphoma Leukemia

"I will report this to the pediatrician."

Parents tell the nurse who is admitting their infant for a well-child exam that they recently saw a "white glow" in their child's left pupil. What is the nurse's best response? "A plugged tear duct would not be unusual." "Has your baby been rubbing either eye?" "I will report this to the pediatrician." "Most parents mention a red color."

petechiae.

The nurse is assessing a child and notices pinpoint hemorrhages appearing on several different areas of the body. The hemorrhages do not blanch on pressure. The nurse documents this finding as: petechiae. poikilocytosis. ecchymosis. purpura.

Calling the doctor if the child gets a sore throat

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 Using acetaminophen if the child needs an analgesic Keeping a written copy of the treatment plan Writing down phone numbers and appointments

Risk for bleeding related to insufficient platelet formation

Which nursing diagnosis should the nurse identify as being the most appropriate for a child with idiopathic thrombocytopenic purpura? Risk for bleeding related to insufficient platelet formation Risk for infection related to abnormal immune system Risk for altered urinary elimination related to kidney impairment Ineffective breathing pattern related to decreased white blood count

Football injuries do not contribute to the development of a tumor.

A high school football player has been diagnosed as having osteosarcoma of the femur. The parents are angry because they told their son not to play football. Which health teaching points would the nurse include in the teaching plan for the adolescent and his parents? You can expect some discoloration of the leg following chemotherapy. Tumor growth is related to your dislike of milk. Football injuries do not contribute to the development of a tumor. Osteosarcoma often follows trauma, such as a football injury.

Using aseptic technique for the procedure.

A nurse is assisting with a bone marrow aspiration and biopsy for a 6-year-old child. Which would be most important? Placing a folded blanket or pillow under the head to raise it. Asking the parents to leave the room for the procedure. Positioning the child on the side. Using aseptic technique for the procedure.

Apply heat to the site of bleeding.

A nurse is preparing a teaching plan for a child with hemophilia and his parents. Which information would the nurse be least likely to include to manage a bleeding episode? Administer factor VIII replacement. Apply direct pressure to the area. Apply heat to the site of bleeding. Elevate the injured area such as a leg or arm.

Brush his or her teeth

The child is prescribed liquid ferrous sulfate. The nurse should encourage the child to take which action immediately after each dose to best eliminate possible side effects? Brush his or her teeth Not eat or drink for one hour Remain in an upright position for at least 15 minutes Drink a glass of milk

"I know this is scary, but leukemia has a high cure rate in children these days."

The health care provider has just informed the parents of a 3-year-old that their child has leukemia. The mother begins crying and tells the nurse she does not want her baby to die. What is the nurse's best response? "You are very lucky to have caught it so early; that makes the treatments easier." "Don't worry, the health care provider is very good at treating leukemia." "I don't blame you for being upset; any parent would be scared too." "I know this is scary, but leukemia has a high cure rate in children these days."

vaccine against human papillomavirus (HPV)

The school nurse is providing information to parents of adolescents about prevention of cervical cancer. Which information is included in the teaching? Papanicolaou tests for adolescent girls vaccine against human papillomavirus (HPV) abstinence from sexual intercourse use of condoms for sexually active teens

Administering the measles, mumps, rubella (MMR) vaccine

The toddler with a cancer diagnosis is seen for a well-child checkup. Which health maintenance activity will the nurse exclude? Teaching the importance of taking water safety measures Assessing dietary intake by addressing "picky eating" and "food jags" Administering the measles, mumps, rubella (MMR) vaccine Plotting height and weight on a growth chart

The prognosis for retinoblastoma is good. Follow-up evaluations will be needed for vision changes. All children in the family will need to have eye examinations. Future testing will need to be done to determine if metastasis has occurred.

A young child has just received a prosthesis following enucleation due to retinoblastoma. Which nursing instruction is appropriate? Select all that apply. Future testing will need to be done to determine if metastasis has occurred. Follow-up evaluations will be needed for vision changes. All children in the family will need to have eye examinations. Surgery provides a cure for this malignancy, and no chemotherapy will be needed. The prognosis for retinoblastoma is good. Remove the prosthesis daily for cleaning.

cheeseburger, broccoli, and fresh strawberries

The nurse will select which meal as the best choice for a child with iron-deficiency anemia? chicken breast, French fries, and sweetened tea two slices of pepperoni pizza and a glass of skim milk cheeseburger, broccoli, and fresh strawberries peanut butter sandwich, cheese stick, and applesauce

"These values will help us monitor the disease."

The nurse is caring for a child with aplastic anemia. The nurse is reviewing the child's blood work and notes the granulocyte count is about 500, platelet count is over 20,000, and the reticulocyte count is over 1%. The parents ask if these values have any significance. Which response by the nurse is appropriate? "These values will help us monitor the disease." "I'm really not allowed to discuss these findings with you." "The doctor will discuss these findings with you when he comes to the hospital." "These labs are just common labs for children with this disease."

Administering oxygen Administering analgesics Maintaining fluid intake

The nurse is working with a child who is in sickle cell crisis. Treatment and nursing care for this child include which actions? Select all that apply. Administering oxygen Administering analgesics Promoting exercise and activity Maintaining fluid intake Administering platelets

Bladder

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? Bladder Brain Blood Kidney

Have the parent bring the child to the pediatric oncology clinic as soon as possible.

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? Instruct the parent to immediately obtain and give the antibiotic that the oncologist will order. Have the parent bring the child to the pediatric oncology clinic as soon as possible. Ask whether any family members or other close associates are ill. Tell the parent to administer acetaminophen every 4 hours until the fever dissipates.

Factor VIII

A toddler who is beginning to walk has fallen and hit his head on the corner of a low table. The caregiver has been unable to stop the bleeding and brings the child to the pediatric clinic. The nurse is gathering data during the admission process and notes several bruises and swollen joints. A diagnosis of hemophilia is confirmed. This child most likely has a deficiency of which blood factor? Factor XIII Factor VIII Factor X Factor V

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

The nurse caring for a 14-year-old scheduled for magnetic resonance imaging (MRI) explains to a family how the test works. Which response accurately describes this test? "The MRI uses radiation to examine soft tissue and bony structures of the body." "The MRI is a nuclear scanning test to rule out cancer involving the bones or determine extent of bone involvement." "The MRI uses radio waves and magnets to produce a computerized image of the body." "The MRI uses sound waves to create images that visualize body structures and locate masses."

tachycardia and respiratory distress

The nurse is caring for a 6-year-old girl with leukemia who is having an oncologic emergency. Which signs and symptoms would indicate hyperleukocytosis? tachycardia and respiratory distress bradycardia and distinct S1 and S2 sounds wheezing and diminished breath sounds respiratory distress and poor perfusion

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

The nurse is teaching the parents of a 15-year-old boy who is being treated for acute myeloid leukemia about the side effects of chemotherapy. For which symptoms should the parents seek medical care immediately? earache, stiff neck, or sore throat difficulty or pain when swallowing temperature of 101°F (38.3°C) or greater blisters, ulcers, or a rash appear

"ITP is primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason."

The parents of a 6-year-old child with idiopathic thrombocytopenic purpura (ITP) ask the nurse, "What causes this disease?" Which response by the nurse would be most appropriate? "ITP is primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason." "ITP is a serious bleeding disorder characterized by a decreased, absent, or dysfunctional coagulation." "ITP is characterized by the loss of surface area on the red blood cell membrane." "ITP occurs when the body's iron stores are depleted due to rapid physical growth, inadequate iron intake, inadequate iron absorption, or loss of blood."

Encourage the adolescent to select hats or wigs to fit one's personality.

An adolescent receiving chemotherapy has lost all hair and is sad about self-image. Which action should the nurse take to support this adolescent and involve the client in decision making? Have a Child Life specialist work with the adolescent. Refer the adolescent to a peer support group. Encourage the adolescent to select hats or wigs to fit one's personality. Support the adolescent's choice of comfortable clothing.