Quiz 4

Parents ask why their child just diagnosed with leukemia needs a "spinal tap." Which is the best response by the nurse?

"Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system."Explanation:The cerebrospinal fluid is checked so the clinician can determine whether leukemic cells have invaded the central nervous system. It is common for a chemotherapy medication, usually methotrexate, to be administered immediately following lumbar puncture as treatment for potential infiltration. The other responses are incorrect.

The nurse is taking a health history of a 6-week-old boy with a suspected cardiovascular disorder. Which response by the mother would lead the nurse to suspect that the child is experiencing heart failure?a) "He does not seem short of breath."b) "He gets sweaty when he eats."c) "He does not seem sick."d) "He seems to have a normal appetite."

"He gets sweaty when he eats."

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.""I know this is scary, but leukemia has a high cure rate in children these days.""I don't blame you for being upset; any parent would be scared too.""Don't worry, the health care provider is very good at treating leukemia."

"I know this is scary, but leukemia has a high cure rate in children these days." Although cancer in children is rare compared to unintentional injury or infection, it is the leading medical cause of death among persons younger than 25 years of age. Fortunately, the overall survival rate for children with cancer today has improved. The overall 5-year survival rate is 84.5%, and for acute lymphoblastic leukemia (the most common form of childhood cancer), the 5-year survival is 88.5%

In discussing the causes of iron deficiency anemia in children with a group of nurses, the following statements are made. Which of these statements is a misconception related to iron deficiency anemia?a) "Milk is a perfect food, and babies should be able to have all the milk they want."b) "Caregivers sometimes don't understand the importance of iron and proper nutrition."c) "Children have a hard time getting enough iron from food during their first few years."d) "A family's economic problems are often a cause of malnutrition."

"Milk is a perfect food, and babies should be able to have all the milk they want."

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.""When I give my son ferrous sulfate I know he also needs potassium supplements.""I always give the ferrous sulfate with meals.""We watch closely for any diarrhea since that usually happens when he takes ferrous sulfate." "My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C."When ferrous sulfate is administered, it should be given between meals with juice (preferably orange juice, because vitamin C aids in iron absorption). For best results, iron should not be given with meals. Ferrous sulfate can cause constipation or turn the child's stools black.

"My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C." When ferrous sulfate is administered, it should be given between meals with juice (preferably orange juice, because vitamin C aids in iron absorption). For best results, iron should not be given with meals. Ferrous sulfate can cause constipation or turn the child's stools black.

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 edema cause by tumor necrosis." Explanation: 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 inflamm ... (more)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 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.""The numbing medicine on your skin will keep you from having pain.""You may feel pressure on your hip during the procedure.""You will have to lie on your back and hold your breath."

"You may feel pressure on your hip during the procedure." The bone marrow aspiration is performed on the iliac crest if the child is older and on the femur if the child is an infant. Bone marrow aspiration requires hard pressure to allow the needle to puncture the bone. A lidocaine/prilocaine cream is applied to the skin anywhere from 1 to 3 hours prior to the procedure to help numb the site where the needle will be inserted. Bone marrow aspirations and biopsies are usually performed with conscious sedation. If the child is an infant or there are special circumstances the procedure may be performed under anesthesia. The child is placed on the side for the procedure so the health care provider has better access to the iliac crest. The child will need to rest after the procedure to prevent bleeding, but is not required to lay flat on the back. Children who have had a lumbar puncture may need to lie on the back and are at risk for a headache.

A child with leukemia received chemotherapy about 10 days ago. She presents today with a temperature of 100.4°F, an absolute neutrophil count of 500, and mild bleeding of the gums. What is the priority nursing intervention? Administer IV antibiotics as ordered. Provide vigorous oral care frequently with a firm toothbrush. Monitor pulse and blood pressure for changes. Administer packed red blood cell transfusion.

Administer IV antibiotics as ordered.

A nurse is caring for an infant who is experiencing heart failure. Which of the following would be the most appropriate care for this infant?a) Administer oxygen.b) Restrict fluids.c) Provide large, less frequent feedings.d) Administer antidiuretic.

Administer oxygen.

The nurse is caring for a child who has just been admitted to the pediatric unit with sickle cell crisis. He is complaining that his right arm and leg hurt. What is the priority nursing intervention? Administer pain medication every 3 hours intravenously until pain is controlled. Perform passive range of motion of the arm and leg to maintain function. Try acetaminophen for pain first, moving up to opioids only if needed. Use narcotic analgesics and warm compresses as needed to control the pain.

Administer pain medication every 3 hours intravenously until pain is controlled.

A child with leukemia has the following AM laboratory results: Hgb 8.0, Hct 24.2, WBC 8,000, platelets 150,000. What is the priority nursing assessment? Monitor for fever. Assess for bruising or bleeding. Determine intake and output. Assess for pallor, fatigue, and tachycardia.

Assess for pallor, fatigue, and tachycardia.

Which of the following would be included in the care of an infant in heart failure?a) Begin formulas with increased calories.b) Encourage larger, less frequent feedings.c) Maintain child in the supine position.d) Administer digoxin even if the infant is vomiting

Begin formulas with increased calories.

The nurse is admitting to an examination room a child with the diagnosis of "probable acute lymphoblastic leukemia." What will confirm this diagnosis?

Bone marrow aspiration Explanation:Bone marrow aspiration and biopsy are diagnostic. An abnormal white blood count and symptoms of lethargy, bruising, and pallor only create suspicion of leukemia; a twin may or may not be affected.

The nurse is assessing an 11-year-old girl diagnosed with acute myelogenous leukemia (AML) who came to the emergency department. Which of the following would alert the nurse to the need for immediate intervention?

CBC indicates hyperleukocytosis. Explanation: About 25% of children with acute myelogenous leukemia present with blood counts greater than 100,000. This is called hyperleukocytosis, and it is a medical emergency requiring leukapheresis to decrease hyperviscosity by quickly decreasing the number of circulating blasts. Lymphadenopathy, headache, visual disturbance, weight loss, and muscle wasting are signs and symptoms common to both types of leukemia. Lymphadenopathy is a common manifestation associated with AML and does not require immediate intervention. Headache and vision problems are common manifestations associated with AML. They do not require immediate intervention. Weight loss and muscle wasting are common manifestations associated with AML. They do not require immediate intervention.

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 throatExplanation:Calling the doctor if the child gets a sore throat is the priority. Because of the child's impaired immune system, any sign of potential infection, such as sore throat, must be evaluated by a physician. Using acetaminophen if the child needs an analgesic, writing down phone numbers and appointments, and keeping a written copy of the treatment plan are important teaching points but secondary to guarding against infection.

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

Child complains of facial palsy and vision problemsCorrectExplanation:The presence of facial palsy and vision problems indicates that the central nervous system has been infiltrated by leukemia cells. The petechiae, purpura, or unusual bruising results from decreased platelet levels and may be present regardless of metastasis. Adventitious breath sounds may indicate pneumonia, and may be present whether the disease has metastasized or not. Hepatomegaly and splenomegaly result from infection, not metastasis.

A 5-year-old who had a renal transplant 9 months ago and has no history of chickenpox presents to the pediatric clinic for his vaccinations. Which is the most appropriate set to give? DTaP, IPV DTaP, IPV, MMR, varicella DTaP, IPV, varicella IPV only

DTaP, IPV

The nurse is caring for an 18-month-old with suspected iron deficiency anemia. Which lab results confirm the diagnosis?a) Increased serum iron and ferritin levels, decreased FEP level, microcytosis and hypochromiab) Decreased hemoglobin and hematocrit, decreased reticulocyte count, microcytosis, and hypochromia, decreased serum iron and ferritin levels and increased FEP levelc) Increased hemoglobin and hematocrit, increased reticulocyte count, microcytosis, and hypochromiad) Increased hemoglobin and hematocrit, increased reticulocyte, microcytosis and hypochromia, increased serum iron and ferritin levels, and decreased FEP level Decreased hemoglobin and hematocrit, decreased reticulocyte count, microcytosis, and hypochromia, decreased serum iron and ferritin levels and increased FEP level

Decreased hemoglobin and hematocrit, decreased reticulocyte count, microcytosis, and hypochromia, decreased serum iron and ferritin levels and increased FEP level

A nurse admits an infant with a possible diagnosis of congestive heart failure. Which of the following signs and symptoms would the infant most likely be exhibiting?a) Rapid weight gainb) Yellowish colorc) Bradycardiad) Feeding problems

Feeding problems

While assessing a neonate with a ventricular septal defect (VSD), the nurse notes crackles and retractions. The nurse obtains the following vital signs: temp 100.2°F (38°C), pulse 134 bpm, respirations 64 breaths/minute, oxygen saturation 97% on room air. What will the nurse do first?Administer acetaminophen rectally.Advise the mother to bottle feed.Apply oxygen 10 liters/min (LPM) via oxyhood.Give furosemide intravenously.

Give furosemide intravenously. The nurse's first action when a neonate with a cardiac disorder is experiencing signs of fluid overload but has a normal oxygen saturation is to administer a diuretic such as furosemide. Oxygen could be applied if the furosemide was not effective in reducing fluid overload or if the oxygen saturation was low. This will remove fluid from the lungs, allowing the infant to breathe more easily. Although the neonate has an elevated temperature, administration of acetaminophen does not take priority over breathing. If the neonate continues to show signs of pulmonary overload, the nurse could advise the mother to give expressed breast milk through a bottle or nasogastric tube.

An 8-month-old infant has a ventricular septal defect. Which nursing diagnosis would best apply?Impaired gas exchange related to a right-to-left shuntIneffective airway clearance related to altered pulmonary statusImpaired skin integrity related to poor peripheral circulationIneffective tissue perfusion related to inefficiency of the heart as a pump

Ineffective tissue perfusion related to inefficiency of the heart as a pump A ventricular septal defect permits blood to flow across an opening between the right and left ventricles. It results in increased pulmonary blood flow, but it does not cause cyanosis. The blood in the left ventricle, which flows back into the right ventricle, is already oxygenated. Anytime there is an opening between the heart's ventricles, the heart is not as effective as a pump because the pressure gradients are changed. A ventricular septal defect will not cause respiratory problems or problems with peripheral circulation.

The nurse is caring for a child who has been admitted for a sickle cell crisis. What would the nurse do first to provide adequate pain management?

Initiate pain assessment with a standardized pain scale. Explanation:The nurse should first initiate pain assessment with a standardized pain scale upon admission and provide frequent evaluations of pain. Administering NSAIDs or meperidine and the use of nonpharmacologic pain management techniques are all appropriate. However, the first action is to assess the child's pain to provide a baseline for future comparison.

A nurse is assessing the skin of a 12-year-old with suspected right ventricular heart failure. Where should the nurse expect to note edema in this child?a) Presacral regionb) Lower extremitiesc) Handsd) Face

Lower extremities

The child has been diagnosed with leukemia. Rank the following medications used to treat leukemia in order based on the stage of treatment.

Oral steroids and vincristine through an intravenous lineHigh-dose methotrexate and 6-mercaptopurineLow doses of 6-mercaptopurine and methotrexateChemotherapy through an intrathecal catheterExplanation:During induction, the child receives oral steroids and IV vincristine. During consolidation, the child receives high doses of methotrexate and 6-mercaptopurine. During maintenance, the child receives low doses of methotrexate and 6-mercaptopurine. During central nervous system prophylaxis, the child receives intrathecal chemotherapy.

A nurse is caring for a child with Kawasaki disease. Which assessment finding would the nurse expect to see?a) Peeling hands and feet and feverb) Decreased heart rate and impalpable pulsec) Low blood pressure and decreased heart rated) Irritability and dry mucous membranes

Peeling hands and feet and fever

Which of the following would be most important to implement for an infant who develops heart failure?a) Placing her in a semi-Fowler's positionb) Keeping her supine and playing quiet gamesc) Planning ways to reduce salt intaked) Restricting milk intake daily

Placing her in a semi-Fowler's position

A child is diagnosed with iron deficiency anemia. Which diagnostic test would the nurse suspect as being the most sensitive test for determining this disorder?a) Hemoglobin electrophoresisb) Serum iron levelc) Reticulocyte countd) Serum ferritin

Serum ferritin

The nurse is examining the hands of a child with suspected iron deficiency anemia. Which finding should the nurse expect?a) Capillary refill in less than 2 secondsb) Spooning of nailsc) Pink palms and nail bedsd) Absence of bruising

Spooning of nails

A nurse is caring for a child who is experiencing heart failure. Which of the following assessment data was most likely seen when initially examined?a) Polyuriab) Tachycardiac) Bradycardiad) Splenomegaly

Tachycardia

The nurse is caring for a 6-year-old girl with leukemia who is having an oncological emergency. Which of the following signs and symptoms would indicate hyperleukocytosis?

Tachycardia and respiratory distressExplanation:Increased heart rate, murmur, and respiratory distress are symptoms of hyperleukocytosis (high white blood cell count) which is associated with leukemia. Increased heart rate and blood pressure are indicative of tumor lysis syndrome, which may occur with acute lymphoblastic leukemia, lymphoma, and neuroblastoma. Wheezing and diminished breath sounds are signs of superior vena cava syndrome related to non-Hodgkin's lymphoma or neuroblastoma. Respiratory distress and poor perfusion are symptoms of massive hepatomegaly which is caused by a neuroblastoma filling a large portion of the abdominal cavity.

The nurse is caring for a 3-year-old child with the surgical repair of hypospadias. The preschooler returned from the postanesthesia care unit with an indwelling urinary catheter. What parental teaching is most helpful?The child must be reevaluated at puberty for testicular function.The catheter insertion site will leave only a minimal scar.Back pressure from such drainage may result in nephrotic syndrome.The child will always have tenderness on penile erection.

The catheter insertion site will leave only a minimal scar.Hypospadias is a urethral defect in which the opening is on the ventral surface rather than at the end of the penis. If left untreated, it may mean the boy will not be able to void standing as the aim will be different; in addition, it will cause interference with the deposition of sperm during intercourse. The completed surgery requires the use of a catheter. The catheter, along with the penis, is taped to the abdomen to reduce pressure on the urethral sutures. The tube insertion site will leave only a minimal scar, if any. A hypospadias repair should have no long-term consequences.

For the child diagnosed with iron deficiency anemia, what would the nurse anticipate would be done in treating this disorder?a) The child would be given corticosteroids via a metered-dose inhaler.b) The child would be given a high dose of intravenous immunoglobulin.c) The child would be given enteric-coated aspirin with milk.d) The child would be given ferrous sulfate with orange juice between meals.

The child would be given ferrous sulfate with orange juice between meals.

A newborn is diagnosed with hypospadias and the parents want him to be circumcised. What would be the best response by the nurse?a) Circumcision is usually performed after 1 year old.b) Circumcision with a hypospadias will cause meatal stenosis.c) The foreskin is needed for repair.d) The circumcision may predispose the child to renal failure.

The foreskin is needed for repair.CorrectExplanation:A child's foreskin is not removed since it is needed to help repair a hypospadias. Once the hypospadias is repaired, a circumcision can be performed at the same time. Meatal stenosis has to do with the urethral opening diameter, not the placement

When examining a child with congenital heart disease, an organ in the upper right quadrant of the abdomen can be palpated at 4 cm below the rib cage. Which of the following would most likely explain this assessment finding?a) The spleen increases due to increased destruction of red blood cells.b) The liver increases due to cardiac medications.c) The spleen increases due to frequent infection.d) The liver increases in right-sided heart failure. The liver increases in right-sided heart failure.

The liver increases in right-sided heart failure.

The home care nurse is conducting an in-home visit for a child who had corrective surgery for hypospadias 3 days prior. What would alert the home care nurse to provide additional teaching?The parent indicates the child is fussy but calms down when held on the parent's hip.The parent states, "I have had to buy more diapers since having to double diaper him."The parent states, "I cannot wait until I can bathe him the tub again...he enjoys it so much."The parent expresses relief that the child was not also diagnosed with cryptorchidism at birth.

The parent indicates the child is fussy but calms down when held on the parent's hip.Hypospadias is a condition in which the urethral opening is on the ventral surface of the penis. Surgical repair involves a catheter or stent left in place for 3 to 7 days postoperatively. Activities or play that involves straddling (such a being carried on the parent's hip) are discouraged to prevent trauma to the surgical site and catheter or stent. The child should be double diapered to prevent stool from contaminating the catheter or stent and operative site and causing an infection. The child should not be bathed in a tub until the catheter or stent is removed. Cryptorchidism is a common diagnosis along with hypospadias.

A parent is asking for more information about their infant's patent ductus arteriosus (PDA). What would be included in the education?a) Your child may need multiple surgeries to correct this defect.b) This is caused by an opening that usually closes by 1 week of age.c) This type of defect is caused by having a genetic predisposition for it.d) An IV for fluids will be started immediately. This is caused by an opening that usually closes by 1 week of age.

This is caused by an opening that usually closes by 1 week of age.

The nurse is caring for a child with congestive heart failure and is administering the drug digoxin. At the beginning of this drug therapy the process of digitalization is done for which of the following reasons?a) To decrease the pain to a tolerable levelb) To build the blood levels to a therapeutic levelc) To establish a maintenance dose of the drugd) To increase the heart rate

To build the blood levels to a therapeutic level

The nurse is caring for a child in sickle cell crisis. To best promote hemodilution, the nurse would expect to administer how much fluid per day intravenously or orally? a) 120 mL/kg of fluids per day b) 150 mL/kg of fluids c) 130 mL/kg of fluids per day d) 110 mL/kg of fluids

b) 150 mL/kg of fluids

The nurse is administering meperidine as ordered for pain management for a 10-year-old boy in sickle cell crisis. The nurse would be alert for: a) leg ulcers .b) seizures.' c) priapism. d) behavioral addiction.

b) seizures

The nurse is preparing a child for discharge following a sickle cell crisis. Which statement by the mother indicates a need for further teaching? a) "I put her legs up on pillows when her knees start to hurt." b) "I bought the medication to give to her when she says she is in pain." c) "She has been down, but playing in soccer camp will cheer her up." d) "She loves popsicles, so I'll let her have them as a snack or for dessert."

c) "She has been down, but playing in soccer camp will cheer her up."

A school-aged child is admitted to the hospital with a vaso-occlusive sickle cell crisis. Which measure in his care should be given priority? a) Seeing that he ingests a protein-rich diet b) Encouraging him to take deep breaths hourly c) Maintaining a fluid intravenous line d) Beginning active range-of-motion exercises

c) Maintaining a fluid intravenous line

To prevent further sickle cell crisis, you would advise the parents of a child with sickle cell anemia to: a) encourage the child to participate in school activities, such as long-distance running. b) administer an iron supplement daily. c) prevent the child from drinking an excess amount of fluids per day. d) notify a health care provider if the child develops an upper respiratory infection.

d) notify a health care provider if the child develops an upper respiratory infection. Explanation:Reduction of oxygen and dehydration lead to increased sickling of cells. Early prevention of these with respiratory illness is important

A 4-year-old child has developed acute lymphoblastic leukemia (ALL). Nursing care for the child with ALL involves taking axillary, rather than rectal, temperatures because the child:has a low platelet count.has a low white blood cell count.is prone to diarrhea.is anemic.

has a low platelet count. In ALL, the bone marrow becomes unable to maintain the normal levels of red blood cells, white blood cells, and platelets. Children with ALL bruise and bleed easily. If a rectal thermometer is inserted it can cause bleeding from the irritation of the mucosal membrane because of the decreased platelet count. Using a rectal thermometer also is invasive so there is a large possibility of introducing microorganisms to the child. This could be damaging to the child if the child is neutropenic and has no immune defenses. The child may be prone to diarrhea because of the chemotherapy drugs but that is not the primary reason for not using the rectal temperature. Nursing care for the child should also be provided in the least invasive manner possible. That means not using any IM or SQ injections.

A nurse is teaching the parents of a child with sickle cell disease about factors that predispose the child to a sickle cell crisis. The nurse determines that the teaching was successful when the parents identify what as a factor?

infection Factors that may precipitate a sickle cell crisis include: fever, infection, dehydration, hot or humid environment, cold air or water temperature, high altitude, or excessive physical activity. Respiratory distress and pallor are general signs and symptoms of a sickle cell crisis.

A child with ALL is given leucovorin, a folinic acid, after high-dose methotrexate therapy. It is important to administer this drug because leucovorin

prevents methotrexate that is not incorporated into leukemia cells from entering normal cells.Explanation:Leucovorin "rescue" prevents methotrexate from entering normal cells.

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 throatblisters, ulcers, or a rash appeartemperature of 101°F (38.3°C) or greaterdifficulty or pain when swallowing

temperature of 101°F (38.3°C) or greaterThe parents should seek medical care immediately if the child has a temperature of 101°F (38.3° C) or greater. This is because many chemotherapeutic drugs cause bone marrow suppression; the parents must be directed to take action at the first sign of infection in order to prevent overwhelming sepsis. The appearance of earache, stiff neck, sore throat, blisters, ulcers, or rashes (or difficulty/pain when swallowing) are reasons to seek medical care, but are not as grave as the risk of infection.

The nurse is working with a child who is in sickle cell crisis. Treatment and nursing care for this child includes which actions? Select all that apply. a) Preventing injury and bleeding episodes b) Administering analgesics c) Administering oxygen d) Maintaining fluid intake e) Promoting exercise and activity

• Administering oxygen • Maintaining fluid intake • Administering analgesics

Parents bring their daughter to the health care facility for evaluation. They report that lately the child seems rather pale and really tired. Which of the following 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 feverExplanation:Assessment findings associated with ALL include low-grade fever, lethargy, petechiae, bleeding from the oral mucous membranes, and easy bruising. As the spleen and liver begin to enlarge, abdominal pain, vomiting, and anorexia occur. Physical assessment reveals painless, generalized swelling of lymph nodes, especially the submaxillary or cervical nodes.

A group of nursing students is discussing the diagnosis of iron deficiency anemia, and one of the students asks what foods would be good for this child to eat. Which foods are high in iron? Select all that apply.a) Egg yolksb) Oatmealc) Raisinsd) Cheesee) Peanut butterf) Milk

• Egg yolks• Raisins• Peanut butter• Oatmeal

The nurse is reviewing the health history and physical examination of a child diagnosed with heart failure. What would the nurse expect to find? Select all that apply.a) Shortness of breath when playingb) Bradycardiac) Crackles on lung auscultationd) Hypertensione) Tiring easily when eating

• Tiring easily when eating• Shortness of breath when playing• Crackles on lung auscultation