Pediatric hematology PrepU
A nurse is reviewing the above laboratory results for a 6-year-old child during a pediatric clinic visit. Based on the laboratory results, what question is most appropriate for the nurse to ask the parents?
"What has your child's activity level been like recently?"
A teenage girl asks why chemotherapy causes hair loss. Which response by the nurse is accurate?
Chemotherapy affects cancer cells and normal cells that multiply rapidly
Which diagnosis would be most appropriate for an infant with a large retinoblastoma after surgery?
Disturbed sensory perception related to enucleation
The nurse is assessing a child who is experiencing an acute splenic sequestration secondary to sickle cell disease. What treatment would be a priority?
Emergent transfusion
A 9-year-old child with leukemia is scheduled to undergo an allogeneic hematopoietic stem cell transplant. When teaching the child and parents, what information would the nurse include?
"We'll need to have a match to a donor."
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 may feel pressure on your hip during the procedure."
A client with cancer is diagnosed with typhlitis. Which emergency intervention would the nurse perform?
Administer broad-spectrum antibiotics intravenously
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?
Administering a sedative as ordered to keep the child still
The nurse is preparing to send a child with cancer for a radiation treatment. Which medication should the nurse provide to premedicate the child for this procedure?
Antiemetic
A child is sent to pediatric intensive care following surgery for a brain tumor. Which prescription would the nurse question?
Elevate head of bed 90 degrees
A nursing instructor is describing childhood hematologic disorders to students. Which would the instructor include as being commonly affected by hematologic disorders? Select all that apply.
Erythrocytes Leukocytes Thrombocytes
The pediatric nurse examines the radiographs of a client that indicate lesions on the bone. This finding is indicative of:
Ewing sarcoma
The nurse is caring for a child with leukemia. Which nursing intervention would be the highest priority for this child?
Following guidelines for reverse isolation
Which nursing diagnosis would be most appropriate for a child with idiopathic thrombocytopenic purpura?
Ineffective tissue perfusion related to poor platelet formation
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?
Mediastinal mass
When providing care for a child immediately after a bone marrow aspiration, which nursing action is priority?
Monitor the site dressing and vital signs
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
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 has mild to moderate iron deficiency
The nurse is caring for a child admitted to the hospital for an open fracture of the femur following a motor vehicle accident. The nurse notes the following lab values: white blood cells 10,000/mm3, hemoglobin 7.9 g/dl (79 g/L), hematocrit 28%, platelets 151,000/mm3. Which nursing action is priority?
Transfuse 1 unit of packed red blood cells
A child is diagnosed with sickle cell anemia. Which test will the nurse expect the primary health care provider to prescribe for this client?
Hemoglobin level
A nurse is caring for a child with Hodgkin disease who is in the induction phase of a chemotherapy regimen. The nurse explains to the parents that the goal of this phase is to:
Kill enough cancerous cells to induce remission
When planning the care for a child with leukemia who is receiving methotrexate, the nurse would assess the child closely for which possible effect?
Mucositis
The pediatric nurse is explaining to a new graduate nurse the differences in planning well-child maintenance for a child with cancer. Which statement by the new nurse demonstrates understanding of the teaching?
No routine live vaccines are administered while on chemotherapy
To prevent further sickle cell crisis, the nurse would advise the parents of a child with sickle cell anemia to:
Notify a health care provider if the child develops an upper respiratory infection
The nurse is completing the health history of a 6-month-old infant with retinoblastoma with the child's parents. Which symptom should the nurse expect that the parents have observed?
One pupil appears white
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
Which intervention is best to use with the 6-year-old who has developed stomatitis as a side effect of chemotherapy?
Practice frequent, gentle oral hygiene
A child diagnosed with hemophilia presents with warm, swollen, painful joints. Which action will the nurse take first?
Prepare to administer factor replacement medication
What is the priority action the nurse should take when caring for a child newly diagnosed with Wilms tumor (nephroblastoma)?
Protect the abdomen from manipulation
A child is undergoing a series of diagnostic tests for a suspected malignancy. Which diagnostic test result is only present in Hodgkin disease?
Reed-Sternberg cells
A child with acute lymphoblastic leukemia (ALL) is receiving methotrexate for therapy. Which nursing diagnosis would best apply during therapy?
Risk for impaired skin integrity related to oral ulcerations associated with chemotherapy
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?
Thalassemia
In caring for a child with sickle cell disease, the highest priority goal is:
The child's fluid intake will improve
A nurse is assisting with a bone marrow aspiration and biopsy for a 6-year-old child. Which would be most important?
Using aseptic technique for the procedure
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?
"Milk is a perfect food, and babies should be able to have all the milk they want."
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 Maintaining fluid intake
What is one advantage of an implanted port (central venous access device) that the nurse will explain to an adolescent?
Body appearance changes very little
The nurse is caring for a child admitted with suspected leukemia. The nurse has taken the child's history and performed an assessment. The nurse will plan to prepare the child for which additional diagnostic test first?
Complete blood cell count (CBC)
A school nurse is teaching a group of parents about signs and symptoms of cancer in children. Which symptom is an early sign of a brain tumor?
Headache, vision changes, and vomiting
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?
The cancer has spread in the brain itself but the chance of complete surgical removal is good.
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?
"Has your child recently had the measles, mumps, rubella (MMR) vaccine?"
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?
"I know this is scary, but leukemia has a high cure rate in children these days."
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."
An 8-month-old girl appears pale, irritable, and anorexic. On blood testing, the red blood cells are hypochromic and microcytic. The hemoglobin level is less than 5 g/100 mL, and the serum iron level is high. Which symptom should the nurse most expect as a result of excessive iron deposits?
An enlarged spleen
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
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?
Encourage the adolescent to select hats or wigs to fit one's personality
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?
Initiate intravenous access
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?
Lungs
A school-aged child is admitted to the hospital with a vaso-occlusive sickle cell crisis. Which measure in the child's care plan should be given priority?
Maintaining fluids through an intravenous line
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?
Uncontrolled bleeding
The school nurse is providing information to parents of adolescents about prevention of cervical cancer. Which information is included in the teaching?
Vaccine against human papillomavirus (HPV)
A 14-year-old girl who is a vegetarian has recently developed anemia. Blood smear results show large, fragile, immature erythrocytes. She claims to take an iron supplement regularly and is surprised to learn that she is anemic, as she is otherwise healthy. As the nurse considers all of the data in the case, which anemia will the nurse discuss when collaborating with the primary healthcare provider?
Vitamin B12 deficiency