🤓CHAPTER 24 PREP U
Reed-Sternberg cells
A child is undergoing a series of diagnostic tests for a suspected malignancy. Which diagnostic test result is only present in Hodgkin disease?
consolidation stage
A child with acute lymphoblastic leukemia (ALL) is starting treatment with methotrexate in an attempt to eradicate the leukemic cells. Which stage of therapy is the child undergoing?
alkylating agent
After teaching a group of nursing students about chemotherapy agents used in treatment cancer, the instructor determines that the teaching was successful when the students identify cisplatin as which type of drug?
The child's fluid intake will improve.
In caring for a child with sickle cell disease, the highest priority goal is:
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?
An implanted port
The nurse will use a special needle to start intravenous (IV) fluids through which central venous access device?
uncontrolled bleeding
The oncology nurse is alert for clients displaying signs and symptoms of disseminated intravascular coagulation (DIC). Which symptom would alert the nurse to this emergency condition?
"The prognosis is favorable with complete surgical resection and the child usually experiences minimal neurologic deficits post-operatively."
The parents of a child diagnosed with cerebral astrocytoma ask the nurse about their child's prognosis. Which response by the nurse would be most appropriate?
"The prognosis is favorable with complete surgical resection, with minimal neurologic deficits postoperatively."
The parents of a child diagnosed with low-grade cerebral astrocytoma ask the nurse about their child's prognosis. Which would be an accurate response?
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?
graft-versus-host disease
A child has undergone a hematopoietic stem cell transplant. When assessing the child, the nurse notes the development of a maculopapular rash on the child's palms and bottoms of the feet. Which condition would the nurse suspect?
disseminated intravascular coagulation
A nurse caring for an 8-year-old child with a bleeding disorder documents the following nursing diagnosis: Ineffective tissue perfusion related to intravascular thrombosis and hemorrhage. This nursing diagnosis would be most appropriate for a child diagnosed with which condition?
sickle cell disease
A nurse in the emergency department is examining a 6-month-old with symmetrical swelling of the hands and feet. The nurse immediately suspects:
complete absence of leukemia cells
A nurse is counseling parents of a child with leukemia regarding the goals of the chemotherapy program for their child. What should the nurse mention as the first goal?
Iliac crest
A nurse is preparing a 7-year-old girl for bone marrow aspiration. Which site should she prepare?
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?
Widely fluctuating blood pressure
A nurse is providing care for a child with disseminated intravascular coagulation (DIC). What would alert the nurse to possible neurologic compromise?
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?
1.0
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?
urine catecholamine metabolites
A nurse practitioner suspects a 13-month-old child has a neuroblastoma. Which diagnostic test would be most helpful in confirming the nurse practitioner's suspicion?
Administer the antiemetic before starting chemotherapy
Antiemetics are ordered to control nausea and vomiting in the child undergoing chemotherapy. How can the nurse most effectively use these medications?
administering prescribed broad-spectrum IV antibiotics
The nurse is caring for 9-year-old boy undergoing chemotherapy whose complete blood count (CBC) with differential reports 7% banded and 13% segmented neutrophils with a white blood cell count of 2,540. He has an oral temperature of 38.6°C (101.5°F). Which intervention would be the priority?
fever with no response to repeated antibiotics
The nurse is meeting with a parent and child at the pediatric clinic. Which statement made by the parent during the history would alert the nurse that there might be a possible malignancy in the child?
"Has your child recently had the measles, mumps, rubella (MMR) vaccine?"
The nurse is obtaining a health history on a child diagnosed with idiopathic thrombocytopenic purpura (ITP). After asking about a viral illness, what question should the nurse ask next to gather more information?
Mediastinal mass
A 14-year-old adolescent with Hodgkin disease is experiencing difficulty breathing and is sent for a radiograph. Which finding should the nurse expect to see on the x-ray report?
"He'll need to have those vitamin shots for the rest of his life."
After teaching the parents of a child diagnosed with pernicious anemia about the disorder and treatment, the nurse determines that the teaching was successful when the parents state:
"Prednisone decreases swelling caused by dead or dying cancer cells."
Parents ask why their child is receiving prednisone to treat leukemia because it is not a chemotherapy drug. Which nursing instruction is most accurate?
"The cancer cells have spread to the lymph nodes."
Parents of a 10-year-old have just been informed that their child has stage III cancer. They ask the nurse what this means. What is the nurse's best response?
The child has Beckwith-Wiedemann syndrome
The nurse is assessing a 4-year-old girl whose mother reports that she is not eating well, is losing weight, and has started vomiting after eating. Which risk factor from the health history suggests the child may have a Wilms tumor?
The child has Beckwith-Wiedemann syndrome.
The nurse is assessing a 4-year-old girl whose mother reports that she is not eating well, is losing weight, and has started vomiting after eating. Which risk factor from the health history suggests the child may have a Wilms tumor?
Slightly yellow sclera
The nurse is assessing a school-aged child with sickle-cell anemia. Which assessment finding is consistent with this child's diagnosis?
Severe bone pain
The nurse is assessing an adolescent with suspected osteosarcoma. What would the nurse be least likely to assess?
Deferasirox
The nurse is caring for a 10-year-old girl with iron toxicity. What would the nurse expect the physician to order?
Monitoring for allergic reactions or anaphylaxis.
The nurse is caring for a 6-year-old boy with non-Hodgkin lymphoma who is being treated with monoclonal antibodies. What recommendation would the nurse include in the child's plan of care?
150 ml/kg of fluids
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?
Notify the physician.
The nurse is caring for a child with disseminated intravascular coagulation (DIC). The nurse notices signs of neurologic deficit. Which nursing action is appropriate?
allopurinol
What would the nurse expect to be ordered for a child with acute lymphoblastic leukemia who develops tumor lysis syndrome?
increasing the daily fluid intake
A 12-year-old child is admitted to the hospital with a diagnosis of sickle cell crisis. The nurse has completed an assessment and is creating a plan of care. What aspect of the plan of care is most important to the client's outcome?
has a low platelet count
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:
Group II, favorable prognosis
A child is diagnosed with retinoblastoma in which there are three tumors 4, 5, and 7 disk diameters behind the equator. Using the Reese-Ellsworth staging classification, which describes the staging and prognosis for this condition?
induction
A child is scheduled for chemotherapy as treatment for leukemia. As the nurse is collaborating with another colleague, the discussion turns to the client's first phase of chemotherapy. This phase is known as:
elevate head of bed 90 degrees
A child is sent to pediatric intensive care following surgery for a brain tumor. Which prescription would the nurse question?
Development of toxic iron overload
A client with severe chronic anemia is receiving ongoing transfusion therapy. The nurse frequently assesses the client for what major complication of this therapy?
"Preterm infants are at risk for iron-deficiency anemia."
A mother asks the nurse why her infant who was born at 34 weeks' gestation is being prescribed ferrous sulfate. Which response by the nurse is most appropriate?
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?
urine catecholamines VMA, HVA
The nurse is preparing a child for diagnostic testing because neuroblastoma is suspected. The nurse would most likely prepare the child for which testing?
mucositis
When planning the care for a child with leukemia who is receiving methotrexate, the nurse would assess the child closely for which possible effect?
Ensure all side rails are padded
When providing care for a toddler with hemophilia who is being prepped for an elective procedure, which nursing action is priority?
Disturbed sensory perception related to enucleation
Which diagnosis would be most appropriate for an infant with a large retinoblastoma after surgery?
Implement strategies to address the child's pain.
A 3-year-old child is hospitalized with a diagnosis of sickle cell anemia and is experiencing a pain crisis. Using the FACES scale, the nurse assesses the child's pain to be a 10 on a scale of 1 to 10. The child is receiving intravenous fluids and oxygen at 2 L/min via nasal cannula. The parent is at the bedside holding the child's hand and has a concerned look. What is the nurse's priority in caring for the child?
Inadequate intake of dietary iron in the mother during late gestation
A 4-month-old infant is found to be anemic. Which is the most likely cause of anemia in this child?
The cancer has spread in the brain itself but the chance of complete surgical removal is good.
A 6-year-old child has been found to have a stage II brain tumor. The parent asks the nurse to explain what "stage II" means. Which information would the nurse provide?
Allogeneic
A 9-year-old boy will be undergoing a hematopoietic stem cell transplantation, with donor cells being provided by his 12-year-old sister. The nurse recognizes that this type of transplantation is:
type I
A 9-year-old child is diagnosed with von Willebrand disease with the following characteristics: decreased quantities of all sizes of von Willebrand factor (vWF) multimers and decreased activity of vWF. What type of von Willebrand disease is involved?
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?
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?
Use mild soap and nonscented moisturizer
A mother contacts the oncology nurse concerned about the redness and tenderness of her child's skin following radiation treatments. What is the nurse's best response?
They are cell cycle-nonspecific, destroying both resting and dividing cells.
The health care provider prescribed an alkylating agent for a child's chemotherapy. Which bestdescribes an action produced by these types of agents?
Telling the child exactly what to expect of further treatments.
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?
Administering a sedative as ordered to keep the child still.
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?
Initiate intravenous access
The nurse is caring for a child with sickle-cell anemia admitted to the pediatric unit. The child reports severe pain and fever. The nurse notes the following laboratory values: white blood cells 18,000/mm3, hemoglobin 6.6 mg/dl (66 g/L), and bilirubin 8 mg/dl (136.83 µmol/L). Which nursing action is priority?
complete blood count and iron level
The nurse is caring for an 18-month-old client with suspected iron-deficiency anemia. The nurse will expect to prepare the client for which laboratory tests first?
Thalassemia
The nurse is collecting data from the caregivers of a child brought to the clinic setting. The parents tell the nurse that the child's skin seems to be an unusual color. The nurse notes that the child's skin appears bronze-colored and jaundiced. This observation alerts the nurse to the likelihood that this child has which disorder?
Increased D-Dimer assay
The nurse is preparing a child for diagnostic testing to diagnose disseminated intravascular coagulation (DIC). Which results would the nurse identify as indicating this condition?
10 mg
The nurse is preparing a presentation for a local parent group about nutritional measures to prevent anemia. The group of parents have children between the ages of 4 and 8. The nurse would recommend a daily iron intake of which amount?
joints
The nurse is providing care at a local clinic that treats children with hemophilia. The nurse understands that if bleeding is not treated effectively, the children are at high risk for development of chronic disabling disease involving the:
neuroblastoma
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:
painless, enlarged lymph node
The nurse is reviewing the medical record of a child diagnosed with Hodgkin lymphoma at the asymptomatic stage. Which would the nurse identify as typically the first sign reported by the child?
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?
"She can bring graham crackers and peanut butter."
The nurse is teaching the parents of a 4-year-old girl with thalassemia about sound nutritional choices. The nurse asks the mother about good snack choices to send to preschool. Which response by the mother would indicate a need for further teaching?
Practice frequent, gentle oral hygiene
Which intervention is best to use with the 6-year-old who has developed stomatitis as a side effect of chemotherapy?
"Our child can drink the medicine from a medicine cup."
A child is to receive oral iron therapy in liquid form three times per day. After teaching the parents about administering the iron, which statement indicates a need for additional teaching?
Infuse deferoxamine at home
A child with hypoplastic anemia develops hemosiderosis. What nursing instruction promotes the treatment goals?
"We should administer the drug on an empty stomach."
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:
Hodgkin lymphoma
During a physical examination of a 13-year-old boy, the nurse observes a single, enlarged, rubbery-feeling cervical lymph node in the armpit. The boy also reports unexplained loss of weight and malaise. Which condition should the nurse most suspect in this client?
