Sherpath-Hematologic Cancers
The nurse conducts an assessment on a child who presents with swelling and discomfort in the axilla, persistent cough, and dyspnea. Which assessment is a priority? Temperature Lung sounds Tracheal position Breathing pattern
Tracheal position The nurse would check the position of the trachea. Cough and respiratory distress indicate signs of mediastinal disease, which may also cause tracheal deviation.
The nurse is assessing a female child diagnosed with Hodgkin lymphoma. When taking a patient history, which information from the patient's parents would the nurse expect? Select all that apply. "She has a poor appetite recently." "She has been more colds than usual this year." "She has had a lot of unexplained fevers lately." "She just doesn't have much energy for play anymore." "She has a lump in her neck that is painful when touched."
"She has a poor appetite recently." Anorexia is a clinical manifestation of Hodgkin lymphoma. Loss of appetite for food is expected. "She has had a lot of unexplained fevers lately." Fever is a constitutional symptom of Hodgkin lymphoma and would be an expected symptom. "She just doesn't have much energy for play anymore." Fatigue is a clinical manifestation of Hodgkin lymphoma. Loss of energy or disinterest in physical play is expected.
The nurse is caring for a four-year-old child with leukemia who is receiving chemotherapy. The parent reports that the child has abdominal pain, nausea, and vomiting. Upon exam, the nurse notes poor skin turgor, pallor, dry mucus membranes, and poor appetite. Which action should the nurse take first? Administer pain medicine Assess hourly urine output Administer oral antiemetic Administer normal saline IV bolus
Administer normal saline IV bolus A child with leukemia is at risk for dehydration and fluid and nutrition imbalance. Thus, administering IV bolus of normal saline is a priority nursing intervention to treat signs of dehydration.
A child diagnosed with leukemia reports nausea, vomiting, and anorexia related to chemotherapy treatment. The nurse notes a hemoglobin count of 10, WBC count of 8, platelet count of 103,000, and an albumin level of 2.1. Which prescription would the nurse anticipate? Decrease dietary protein Administer PO allopurinol Administer platelet transfusion Administer total parenteral nutrition
Administer total parenteral nutrition An albumin level of 2.1 indicates malnutrition. The nurse would administer total parenteral nutrition via a central line to improve the child's nutritional status.
A two-year-old child diagnosed with Hodgkin Lymphoma presents with enlarged neck lymph nodes, and an x-ray reveals widening of the mediastinum. Which action should the nurse take first? Prepare for surgical excision Auscultate for bowel sounds Assess the child's airway for patency Educate parents or caregiver on chemotherapy
Assess the child's airway for patency The nurse should assess the airway patency of a child with cervical lymphadenopathy and mediastinal disease from Hodgkin lymphoma, because swelling of cervical lymph nodes and mediastinal disease can cause airway obstruction.
The nurse is educating the parents of a child with leukemia about necessary homecare. During the teaching session, the mother states, "We plan to let him return to baseball practice next week." Which information is most important for the nurse to include in the response? Avoid physically exhausting activities. Apply ample amounts of sunscreen on child's skin while outside. Assess the child's mucus membranes for signs of dehydration frequently while playing. Notify the health care provider immediately if the child has shortness of breath while playing.
Avoid physically exhausting activities. Providing information about activities to be avoided, such as baseball, is the most important teaching that the nurse should provide the mother because patients with leukemia are often thrombocytopenic and neutropenic, and engaging in physically exhausting activities can trigger bleeding, injury, and infection.
A three-year-old child presents to the ER after a sudden onset of nosebleed, small red spots on the skin, stomachache, and poor appetite. Which evaluation should the nurse prepare this child? Flow cytometry Lumbar puncture Bone marrow aspiration Complete blood count (CBC)
Complete blood count (CBC) The nurse prepares the child with a sudden nosebleed, small red spots on the skin, stomachache, and poor appetite for a CBC with a differential count. This lab test is used as an initial evaluation for a suspected case of leukemia. The test would likely reveal a low hemoglobin count, decreased platelets, low white blood cell count, and increased lymphocytes.
The nurse is caring for a child with potential non-Hodgkin Lymphoma (NHL). Which medical history information could increase the child's risk for developing the disease? Select all that apply. Diagnosis of AIDS Diagnosis of chronic pain Family history of diabetes History of kidney transplant Being born to a mother of advanced age
Diagnosis of AIDS AIDS compromises the immune system, which increases the patient's risk for developing NHL. History of kidney transplant Patients who have undergone organ transplantation are at increased risk for developing NHL, because these patients are receiving drugs that weaken their immune system to prevent it from attacking the new organs.
The nurse is assessing a child whose parents report malaise, abdominal pain, knee, and leg pain. The nurse notes significant hepatosplenomegaly. Which other objective findings would indicate a possible leukemia diagnosis? Select all that apply. Elevated WBC count Temperature 99.4 F Depressed platelet count Elevated hemoglobin level Masses in the groin and axillae
Elevated WBC count Malaise, abdominal pain, and hepatosplenomegaly are signs of malignancy. Abnormal WBC would support a possible leukemia diagnosis because of the lack of fully developed leukocytes. Depressed platelet count Malaise, abdominal pain, and hepatosplenomegaly are signs of malignancy. A low platelet count would support a possible leukemia diagnosis because leukemia can be accompanied by thrombocytopenia. Masses in the groin and axillae Malaise, abdominal pain, and hepatosplenomegaly are signs of malignancy. Masses in the groin and axillae would support a possible leukemia diagnosis if lymph nodes are involved.
The nurse is evaluating a child who was admitted for persistent cough, dyspnea, swelling, and discomfort in the neck and axilla. Lymph node biopsy confirmed that the child has Non-Hodgkin Lymphoma. Which question would best determine the effectiveness of nursing care to this patient? Is the child's core body temperature stable? Is the child's urine output sufficient for age? Has the child's respiratory status remained stable? Are the parents knowledgeable about the disease process?
Has the child's respiratory status remained stable? Evaluating the child's respiratory status for rate, rhythm, and breath sounds, and ensuring that they are stable indicates that the nursing care rendered to the child is effective.
The parents of a seven-year-old child report swelling in the child's neck and recent fatigue. They are apprehensive about the diagnosis and ask the nurse about the progression of Hodgkin lymphoma. Which information should the nurse include in the response? Hodgkin Lymphoma begins in the lymph nodes. Hodgkin Lymphoma is an unpredictable condition that spreads rapidly. Hodgkin lymphoma can begin in any site involved in WBC production or storage. Hodgkin lymphoma affects the maturation of WBC and eventually leads to obliteration of the patient's immune function.
Hodgkin Lymphoma begins in the lymph nodes. Hodgkin lymphoma originates in a single lymph node or a group of lymph nodes in the same anatomic region.
The nurse is assessing a child with non-Hodgkin's Lymphoma and notes elevated serum sodium, serum potassium, BUN, and uric acid levels. The child reports urinating only once in the past two days. Which action is most important for the nurse to take? Insert urine catheter. Obtain a urine culture. Initiate IV fluid resuscitation. Monitor serum electrolyte levels.
Initiate IV fluid resuscitation. Elevated serum sodium, serum potassium, BUN, and uric acid levels in a child with non-Hodgkin's Lymphoma who has urinated only once in the past two days indicates a need for intensive IV fluid administration to prevent kidney failure.
A six-year-old child with leukemia presents with altered level of consciousness (LOC) and sluggish pupils but no cardiac compromise after falling from a bike. The nurse notes a platelet count of 10,000, WBC of four, and hemoglobin of seven. After the patient's airway is stabilized, which priority order should the nurse anticipate? Obtain a head CT Assess serum glucose Administer IV fluid bolus Administer pain medication
Obtain a head CT The nurse should first obtain a head CT on a patient with thrombocytopenia and altered LOC after a head injury to evaluate for cerebral hemorrhage.
The nurse is caring for a 16-year-old child diagnosed with Hodgkin Lymphoma who reports shortness of breath, and chest pain. The nurse notes hoarseness of patient's voice when speaking. Which prescription would the nurse take first? Obtain sputum culture Administer pain medication Administer albuterol nebulizer Obtain an emergency chest radiograph
Obtain an emergency chest radiograph Respiratory symptoms and hoarseness suggest mediastinal involvement. Because this can lead to airway obstruction, this must be evaluated immediately. The nurse would obtain a STAT chest x-ray to determine whether a mediastinal tumor is present.
The nurse is caring for a 17-year-old with single-node Hodgkin lymphoma who reports right upper quadrant pain, nausea and vomiting. The nurse notes icteric skin and sclera, and abdominal distention. Which prescription would the nurse anticipate? Administer IV pain medicine Assess serum potassium level Obtain serum AST and ALT levels Administer oral antiemetic medication
Obtain serum AST and ALT levels The patient's symptoms indicate potential hepatomegaly and liver involvement related to Hodgkin lymphoma. The nurse would obtain liver function tests to determine the extent of liver damage.
A child is admitted to the hospital with Non-Hodgkin lymphoma, and reports having lower abdominal pain of 6/10. The nurse notes a temperature of 102.3° F, heart rate 107 and respiratory rate 14. Which actions are most important for the nurse to take? Select all that apply. Assess lung sounds Obtain urine culture Obtain blood culture Obtain uric acid level Administer pain medication
Obtain urine culture A temperature of 102.3 indicates a fever and possible infection. The nurse should obtain a urine culture to identify the cause of infection. Obtain blood culture A temperature of 102.3 indicates a fever and possible infection. The nurse should obtain a blood culture to identify the cause of infection.
A four-year-old child comes to the Emergency Department with his mother, who states that the child is just not feeling himself. The child has been irritable and often seems out of breath. A urinalysis shows evidence of uric acid crystals. Which action should the nurse do first? Prepare child for a chest x-ray Obtain consent for lumbar puncture Discuss with the family about a pelvic CT scan Prepare patient for a bone marrow aspiration and biopsy
Prepare child for a chest x-ray After identifying the presence of hyperuricemia, a chest x-ray is obtained to look for mediastinal disease and tracheal deviation. Thus, the nurse's priority action is to prepare the patient for a chest x-ray, as the child displays signs of potential respiratory compromise.
A two-year-old child presents with fever, night sweats, splenomegaly, and blood studies indicating presence of Reed-Sternberg cells. Which action is a priority for the nurse to take? Administer IV fluids. Obtain a blood sample. Prepare child for gallium scan. Prepare child for bone marrow aspiration.
Prepare child for bone marrow aspiration. Splenomegaly, fevers, night sweats and the presence of Reed-Sternberg cells are signs of Hodgkin lymphoma. The nurse should prepare the child for bone marrow aspiration and biopsy for definitive diagnosis.
The nurse is caring for a child with Non-Hodgkin's Lymphoma who presents in a tripod position, is diaphoretic, and has shortness of breath. The nurse notes a left-sided tracheal deviation, diminished lung sounds on the right side, and SpO2 of 84 percent. Which action is most important for the nurse to take? Administer oxygen Prepare for intubation Administer albuterol nebulizer Obtain a STAT chest radiograph
Prepare for intubation The patient's respiratory compromise is life-threatening. Preparing for intubation is a priority intervention.
A four-year-old child diagnosed with leukemia presents with a headache, nausea and vomiting, and slight confusion. Which action should the nurse take? Secure consent for lumbar puncture. Assess the child's level of consciousness. Administer acetaminophen as prescribed. Reassure parents that symptoms are expected.
Secure consent for lumbar puncture. A child with leukemia who manifests with headache, nausea and vomiting, and slight confusion, indicates central nervous system involvement. The nurse secures an informed consent from the parents or legal guardian, as the child may undergo a lumbar puncture.
