Pediatric Success - Chapter 10 - Hematological/Oncology Disorders

Which of the following confirms a diagnosis of Hodgkin disease in a 15-year-old? 1. Reed-Sternberg cells in the lymph nodes. 2. Blast cells in the blood. 3. Lymphocytes in the bone marrow. 4. VMA in the urine.

*1. A lymph node biopsy is done to confi rm a histological diagnosis and staging of Hodgkin disease. The presence of Reed- Sternberg cells is characteristic of the disease. 2. Blast cells are usually seen with leukemia. 3. A bone marrow aspiration is usually done to diagnose the type of leukemia. 4. This test is done to diagnose neuroblastoma. TEST-TAKING HINT: In reviewing Hodgkin disease, be aware of the specifi c cell identifi ed to confi rm diagnosis.

A child diagnosed with leukemia is receiving allopurinol (Zyloprim) as part of the treatment plan. The parents ask why their child is receiving this medication. What information about the medication should the nurse provide? 1. Helps reduce the uric acid level caused by cell destruction. 2. Helps make the chemotherapy more effective. 3. Helps reduce the nausea and vomiting associated with chemotherapy. 4. Helps decrease pain in the bone marrow.

*1. Allopurinol (Zyloprim) reduces serum uric acid. When there is lysis of cells from chemotherapy, there will be an increase in serum uric acid. 2. There is no specifi c medication that makes chemotherapy more effective. 3. Allopurinol (Zyloprim) is not an antiemetic. 4. Allopurinol (Zyloprim) is not an analgesic. TEST-TAKING HINT: Review the effects of the tumor lysis syndrome that occurs when chemotherapy is started with children with leukemia.

Which of the following measures should be implemented for a child with von Willebrand disease who has a nosebleed? 1. Apply pressure to the nose for at least 10 minutes. 2. Have the child lie supine and quiet. 3. Avoid packing of the nostrils. 4. Encourage the child to swallow frequently.

*1. Applying pressure to the nose may stop the bleeding. In von Willebrand disease, there is an increased tendency to bleed from mucous membranes, leading to nosebleeds commonly from the anterior part of the nasal septum. 2. The child should sit up and lean forward to avoid aspiration of blood. 3. Packing the nose with cotton may stop bleeding, but be careful when the cotton is removed because it may dislodge the clot. 4. Swallowing will cause the child to swallow the blood, which then can cause vomiting. TEST-TAKING HINT: Focus on the most common areas of bleeding in von Willebrand disease and on how to treat the bleeding.

The nurse is caring for a child with a diagnosis of ALL who is receiving chemotherapy. The nurse notes that the child ' s platelet count is 20,000/mm 3 . Based on this laboratory finding, what information should the nurse provide to the child and parents? 1. A soft toothbrush should be used for mouth care. 2. Isolation precautions should be started immediately. 3. The child ' s vital signs, including blood pressure, should be monitored every 4 hours. 4. All visitors should be discouraged from coming to see the family.

*1. Because the platelet count is decreased, there is a significant risk of bleeding, especially in soft tissue. The use of the soft toothbrush should help prevent bleeding of the gums. 2. A low platelet count does not indicate a need to start isolation. 3. There is always a need to monitor the child frequently, but the low platelet count puts the child at risk for bleeding. 4. In caring for children, always screen visitors, but there is no need to restrict visitation unless something is found on the screening. TEST-TAKING HINT: Identify that the platelet count is low and can cause bleeding. The plan of care should include measures to protect the child from bleeding.

A nurse educator is providing a teaching session for the nursing staff. Which of the following individuals is at greatest risk for developing beta-thalassemia (Cooley anemia)? 1. A child of Mediterranean descent. 2. A child of Mexican descent. 3. A child whose mother has chronic anemia. 4. A child who has a low intake of iron.

*1. Beta-thalassemia is an inherited recessive disorder that is found primarily in individuals of Mediterranean descent. The disease has also been reported in Asian and African populations. 2. It is not found often in the Mexican population. 3. This is a hereditary disease that causes chronic anemia. The mother should have had thalassemia for this answer to be correct. 4. This disorder has nothing to do with iron deficiency. TEST-TAKING HINT: Use the process of elimination, knowing that the disorder is a hereditary disorder in those of Mediterranean descent.

Which of the following is correct regarding prognostic factors for determining survival for a child newly diagnosed with ALL? 1. The initial white blood cell count on diagnosis. 2. The race of the child. 3. The amount of time needed to initiate treatment. 4. Children aged 12 to 15 years.

*1. Children with a normal or low white blood cell count who do not have non-T, non-B acute lymphoblastic leukemia and who are CALLA-positive have a much better prognosis than those with high cell counts or other cell types. 2. Race is not a factor in prognosis of leukemia. 3. The child should begin treatment as soon as diagnosed, but time in initiating treatment does not have an effect on prognosis. 4. Children aged 2 to 9 years have the best prognosis. High-risk children include those under 1 year and over 10 years. TEST-TAKING HINT: Review the important prognostic factors that affect longterm survival for children with acute lymphoblastic leukemia.

The nurse is caring for a child with sickle cell disease who is scheduled to have an exchange transfusion. What information should the nurse teach the family? 1. The procedure is done to prevent further sickling during a vaso-occlusive crisis. 2. The procedure reduces side effects from blood transfusions. 3. The procedure is a routine treatment for sickle cell crisis. 4. Once the child ' s spleen is removed, it is not necessary to do exchange transfusions.

*1. Exchange transfusion reduces the number of circulating sickle cells and slows down the cycle of hypoxia, thrombosis, and tissue ischemia. 2. Exchange transfusion does not decrease risk of a transfusion reaction. Every time a transfusion is done, the child continues to be at risk for a reaction. 3. This is not a routine procedure and is performed only when the number of sickle cells is elevated and the child is at high risk for thrombosis. 4. After a splenectomy, transfusions still need to be done depending on the client ' s hemoglobin level. TEST-TAKING HINT: Consider the reasons transfusions are given with sickle cell clients, one of which is exchanging the sickled red cells with non-sickled cells.

The parent of a teen with a diagnosis of Hodgkin disease asks what the child ' s prognosis will be with treatment. What information should the nurse give to the parent and child? 1. Clinical staging of Hodgkin disease will determine the treatment; long-term survival for all stages of Hodgkin disease is excellent. 2. There is a considerably better prognosis if the client is diagnosed early and is less than 5 years of age. 3. The prognosis for Hodgkin disease depends on the type of chemotherapy. 4. The only way to obtain a good prognosis is by chemotherapy and bone marrow transplant.

*1. Long-term survival for all stages of Hodgkin disease is excellent. Early-stage disease can have a survival rate greater than 90%, with advanced stages having rates between 65% and 75%. 2. Hodgkin disease mostly affects adolescents. 3. The treatment consists of chemotherapy and often radiation therapy and does not predict prognosis. 4. Bone marrow transplant is not always necessary with the treatment of Hodgkin disease and will most likely worsen the prognosis. TEST-TAKING HINT: Know the treatments for and the prognosis of Hodgkin disease.

The nurse is caring for a child being treated for ALL. Laboratory results indicate that the child has a white blood cell count of 5000/mm 3 with 5% polys and 3% bands. Which of the following analyses is most appropriate? 1. The absolute neutrophil count is 400/mm 3 , and the child is neutropenic. 2. The absolute neutrophil count is 800/mm 3 , and the child is neutropenic. 3. The absolute neutrophil count is 4000/mm 3 , and the child is not neutropenic. 4. The absolute neutrophil count is 5800/mm 3 , and the child is not neutropenic.

*1. The calculated absolute neutrophil count is 400/mm 3 (0.08 × 5000), and the child is neutropenic because the count is less than 500/mm 3. 2. The absolute neutrophil count is incorrectly calculated. The child would not be neutropenic with a count of 800/mm 3. 3. The absolute neutrophil count is incorrectly calculated. The child would not be neutropenic with a count of 4000/mm 3. 4. The absolute neutrophil count is incorrectly calculated. The child would not be neutropenic if the count were 5800/mm 3. TEST-TAKING HINT: To calculate the absolute neutrophil count, multiply the white blood cell count by the percentage of neutrophils ("polys," "segs," and "bands"). For example: WBC = 1500/mm 3 , neutrophils = 7%, nonsegmented neutrophils (bands) = 7%. 7% + 7% = 14%. 0.14 × 1500 = 210/mm 3 ANC. Precautions for infection should be used at all times with children who are immunosuppressed, but greater precautions must be taken when the ANC is less than 500/mm 3.

Which of the following activities should a nurse suggest for a client diagnosed with hemophilia? Select all that apply. 1. Swimming. 2. Golf. 3. Hiking. 4. Fishing. 5. Soccer.

1, 2, 3, 4. 1. Children with hemophilia should be encouraged to take part in noncontact activities that allow for social, psychological, and physical growth, such as swimming. 2. Children with hemophilia should be encouraged to take part in noncontact activities that allow for social, psychological, and physical growth, such as golf. 3. Children with hemophilia should be encouraged to take part in noncontact activities that allow for social, psychological, and physical growth, such as hiking. 4. Children with hemophilia should be encouraged to take part in noncontact activities that allow for social, psychological, and physical growth, such as fishing. 5. Contact sports like soccer should be discouraged. TEST-TAKING HINT: Soccer is the only contact sport listed, so the other answers can be selected.

The nurse is caring for a child with leukemia. The nurse should be aware that children being treated for leukemia may experience which of the following complications? Select all that apply. 1. Anemia. 2. Infection. 3. Bleeding tendencies. 4. Bone deformities. 5. Polycythemia.

1, 2, 3. 1. Anemia is caused by decreased production of red blood cells. 2. Infection risk in leukemia is secondary to the neutropenia. 3. Bleeding tendencies are from decreased platelet production. 4. There are no bone deformities with leukemia, but there is bone pain from the proliferation of cells in the bone marrow. 5. Polycythemia is an increase in red blood cells. TEST-TAKING HINT: Leukemia is cancer of the blood forming organs. Leukemia can be either acute or chronic. Review the pathophysiology of leukemia to determine the clinical problems.

Which of the following measures should the nurse implement to help with the nausea and vomiting caused by chemotherapy? Select all that apply. 1. Give an antiemetic 30 minutes prior to the start of therapy. 2. Continue the antiemetic as ordered until 24 hours after the chemotherapy is complete. 3. Remove food that has a lot of odor. 4. Keep the child on a nothing-by-mouth status. 5. Wait until the nausea begins to start the antiemetic.

1, 2, 3. 1. The fi rst dose should be given 30 minutes prior to the start of the therapy. 2. Antiemetic should be administered around the clock until 24 hours after the chemotherapy is completed. 3. It is also helpful to remove foods with odor so that the smell of the food does not make the child nauseated. 4. The child should be allowed to take food and fluids as tolerated. 5. Antiemetics are most beneficial if given before the onset of nausea and vomiting. TEST-TAKING HINT: These are measures to prevent nausea and vomiting.

A nurse is caring for a child with von Willebrand disease. The nurse is aware that which of the following is a clinical manifestation of von Willebrand disease? Select all that apply. 1. The child bruises easily. 2. Excessive menstruation. 3. The child has frequent nosebleeds. 4. Elevated creatinine levels. 5. Elevated blood pressure.

1, 2, 3. 1. Von Willebrand disease is a hereditary bleeding disorder characterized by defi ciency of or defect in a protein. The disorder causes adherence of platelets to damaged endothelium and a mild defi ciency of factor VIII. One of the manifestations of this disease is bleeding of the mucous membranes. 2. Excessive menstruation may be a manifestation of this disease. 3. Frequent nosebleeds are a common manifestation of this disease. 4. There is no increase in creatinine in this disease. 5. There is no increase in blood pressure. TEST-TAKING HINT: Von Willebrand disease is a minor factor VIII defi ciency.

Which of the following can be a manifestation of leukemia in a child? Select all that apply. 1. Leg pain. 2. Fever. 3. Excessive weight gain. 4. Bruising. 5. Enlarged lymph nodes.

1, 2, 4, 5. 1. The proliferation of cells in the bone marrow can cause leg pain. 2. Fever is a result of the neutropenia. 3. There is usually a decrease in weight because the child will feel sick and not as hungry. 4. A decrease in platelets causes the bruising. 5. The lymph nodes are enlarged by the infiltration of leukemic cells. TEST-TAKING HINT: Review the consequences of depressed bone marrow and relate them to the clinical manifestations.

A child with hemophilia A fell and injured a knee while playing outside. The knee is swollen and painful. Which of the following measures should be taken to stop the bleeding? Select all that apply. 1. The extremity should be immobilized. 2. The extremity should be elevated. 3. Warm moist compresses should be applied to decrease pain. 4. Passive range-of-motion exercises should be administered to the extremity. 5. Factor VIII should be administered.

1, 2, 5. 1. Measures are needed to induce vasoconstriction and stop the bleeding, including immobilization of the extremity. 2. Measures are needed to induce vasoconstriction and stop the bleeding. Treatment should include elevating the extremity. 3. Measures are needed to induce vasoconstriction and stop the bleeding. Treatment should include an application of cold compression. Warmth will slow the vasoconstriction and clotting process. 4. Measures are needed to induce vasoconstriction and stop the bleeding. Passive ROM is not started until the bleeding has stopped. 5. Hemophilia A is a defi ciency in factor VIII, which causes delay in clotting when there is a bleed. Giving a dose of Factor VIII concentrate will assist in the clotting process. TEST-TAKING HINT: Focus on the disease process and measures to stop bleeding.

Which of the following can lead to a possible diagnosis of human immunodefi ciency virus (HIV) in a child? Select all that apply. 1. Repeated respiratory infections. 2. Intermittent diarrhea. 3. Excessive weight gain. 4. Irregular heartbeat. 5. Poor weight gain.

1, 2, 5. 1. Symptoms of HIV include frequent respiratory infections. The symptoms present based on the underlying cellular immunodeficiency-related disease. 2. Symptoms of HIV include intermittent diarrhea. The symptoms present based on the underlying cellular immunodeficiency-related disease. 3. Children with HIV are unable to create an immune response to infection. They develop recurrent bacterial infections and have poor weight gain. The symptoms present based on the underlying cellular immunodeficiency related disease. 4. Irregular heartbeat is not associated with HIV. 5. Symptoms of HIV include poor weight gain. TEST-TAKING HINT: Symptoms of HIV in children include lymphadenopathy, hepatosplenomegaly, chronic diarrhea, failure to thrive, and parotitis. Review common clinical signs and health conditions associated with the virus.

A nurse is caring for a 15-year-old who has just been diagnosed with non-Hodgkin lymphoma. Which of the following should the nurse include in teaching the parents about this lymphoma? Select all that apply. 1. The malignancy originates in the lymphoid system. 2. The presence of Reed-Sternberg cells in the biopsy is considered diagnostic. 3. Mediastinal involvement is typical. 4. The disease is diffuse rather than nodular. 5. Treatment includes chemotherapy and radiation.

1, 3, 4, 5. 1. Non-Hodgkin disease originates in the lymphoid system. 2. Reed-Sternberg cells are diagnostic for Hodgkin disease and are not seen in non- Hodgkin lymphoma. Reed-Sternberg cells arise from "B" cells and are large, multinucleated cells. 3. Mediastinal involvement is typical. 4. The disease is diffuse rather than nodular. 5. Treatment includes chemotherapy and radiation. TEST-TAKING HINT: The lymphomas are divided into Hodgkin disease (which primarily involves the lymph nodes with metastasis to extra lymphatic sites) and non-Hodgkin lymphoma (a heterogenous condition that has a variety of morphological, cytochemical, and immunological cell features).

Which of the following factors need(s) to be included in a teaching plan for a child with sickle cell disease? Select all that apply. 1. The child needs to be taken to a physician when sick. 2. The parent should make sure the child sleeps in an air-conditioned room. 3. Emotional stress should be avoided. 4. It is important to keep the child well hydrated. 5. It is important to make sure the child gets adequate nutrition.

1, 3, 4, 5. 1. Seek medical attention for illness to prevent the child from going into a crisis. 2. A cold environment causes vasoconstriction, which needs to be prevented to get good tissue perfusion. 3. Stress can cause a depressed immune system, making the child more susceptible to infection and crisis. Parents and children are advised to avoid stress. 4. The child needs good hydration and nutrition to maintain good health. 5. The child needs good hydration and nutrition to maintain good health. TEST-TAKING HINT: Focus on how to prevent a sickle cell crisis.

The nurse is caring for a child who is receiving a transfusion of PRBCs. The nurse is aware that if the child has a hemolytic reaction to the blood, the signs and symptoms would include which of the following? Select all that apply. 1. Fever. 2. Rash. 3. Oliguria. 4. Hypotension. 5. Chills.

1, 3, 4. 1. Hemolytic reactions include fever, pain at insertion site, hypotension, renal failure, tachycardia, oliguria, and shock. 2. Febrile reactions are fever, rash, and chills. Allergic reactions include hives, itching, and respiratory distress. 3. Hemolytic reactions include fever, pain at insertion site, hypotension, renal failure, tachycardia, oliguria, and shock. 4. Hemolytic reactions include fever, pain at insertion site, hypotension, renal failure, tachycardia, oliguria, and shock. 5. Febrile reactions are fever, chills, and rash. Allergic reactions include rash, hives, and respiratory distress. TEST-TAKING HINT: Review the signs and symptoms of hemolytic reaction, febrile reaction, and allergic reaction. Understanding the causes of the reactions will help identify the symptoms.

Which of the following best describes the action of chemotherapeutic agents used in the treatment of cancer in children? Select all that apply. 1. Suppress the function of normal lymphocytes in the immune system. 2. Are alkylating agents and are cell-specific. 3. Cause a replication of DNA and are cell-specific. 4. Interrupt cell cycle, thereby causing cell death. 5. Prednisone is a natural hormone.

1, 4, 5. 1. All chemotherapy is immunosuppressive, because most childhood cancers affect the immune system. 2. Not all chemotherapy drugs are alkylating agents. 3. There is no replication of DNA with chemotherapy. Chemotherapy drugs such as the antimetabolites usually inhibit synthesis of DNA or RNA. 4. Mitotic inhibitors, such as vincristine (Oncovin), stop cell division but can also damage cells in all phases of the cell cycle. 5. The corticosteroids are natural hormones that can be used to prevent nausea and allergic reactions. They are given with other chemotherapeutic agents. TEST-TAKING HINT: Review the function of each type of chemotherapeutic agent. Chemotherapy targets cells at different phases of the cell life cycle.

School-age children with cancer often have a body image disturbance related to hair loss, moon face, or debilitation. Which of the following interventions is (are) most appropriate? Select all that apply. 1. Encourage them to wear a wig similar to their own hairstyle. 2. Emphasize the benefits of the therapy they are receiving. 3. Have them play only with other children with cancer. 4. Use diversional techniques to avoid discussing changes in the body because of the chemotherapy. 5. Help them find a "special friend" who understands what they are experiencing.

1, 5. 1. Wearing a wig is a good way for the child to keep personal identity despite the loss of hair. 2. Just discussing the benefits of the therapy will not help the child with self-image. 3. Having the child play only with other children with cancer could make the child feel even worse because of the inability to interact with friends. The child needs to find acceptance as appearance begins to change. 4. Diverting the child ' s attention would be avoiding the truth and would not be dealing with the issues. 5. Children with cancer and body-image changes oftentimes need assistance in expressing themselves, which a "special friend" can help with. TEST-TAKING HINT: Review the side effects on the body from the chemotherapy and look at ways to help the child deal with body-image changes. Provide the child and family with accurate information of the side effects of the drugs, but also give the child ways to feel good.

Which test provides a defi nitive diagnosis of aplastic anemia? 1. Complete blood count with differential. 2. Bone marrow aspiration. 3. Serum IgG levels. 4. Basic metabolic panel.

1. A complete blood count would show pancytopenia, which would lead the healthcare provider to look for the cause of the blood abnormality. *2. Definitive diagnosis is determined from bone marrow aspiration, which demonstrates the conversion of red bone marrow to yellow, fatty marrow. 3. Serum IgG levels do not diagnose aplastic anemia, which does not seem to have an immune cause. 4. A basic metabolic panel tests for metabolic disorders. TEST-TAKING HINT: Focus on the fact that aplastic anemia is a failure in the bone marrow that causes pancytopenia, so analysis of the bone marrow would confirm the diagnosis.

A 5-year-old is admitted to the hospital with complaints of leg pain and fever. On physical examination, the child is pale and has bruising over various areas of the body. The health-care provider suspects that the child has ALL. The nurse informs the parent that the diagnosis will be confirmed by which of the following? 1. Lumbar puncture. 2. White blood cell count. 3. Bone marrow aspirate. 4. Bone scan.

1. A lumbar puncture is done to look for blast cells in the spinal fluid, which indicate central nervous system disease. It is also done to administer intrathecal chemotherapy, because the chemotherapy that will be given does not pass through the blood-brain barrier. 2. An altered white blood cell count occurs as a result of the disease, but it does not make the diagnosis, as many diseases can alter the white blood cell count. *3. The diagnostic test that confirms leukemia is microscopic examination of the bone marrow aspirate. 4. Bone scans do not confirm the diagnosis of a disease that occurs in the bone marrow. TEST-TAKING HINT: The key to answering this question is the phrase "diagnosis will be confirmed."

Which of the following measures should the nurse teach the parent of a child with hemophilia to do first if the child sustains an injury to a joint causing bleeding? 1. Give the child a dose of acetaminophen (Tylenol). 2. Immobilize the joint and elevate the extremity. 3. Apply heat to the area. 4. Administer factor per the home-care protocol.

1. Acetaminophen (Tylenol) helps with the pain but does not stop the bleeding. 2. Elevating and immobilizing the extremity are good interventions as they decrease blood fl ow. Factor should be administered first, however. 3. Cold, not heat, should be applied to promote vasoconstriction. *4. Administration of factor should be the first intervention if home-care transfusions have been initiated. TEST-TAKING HINT: Treatment of hemophilia is to provide factor replacement as soon as possible after a bleed has started. Application of cold, elevation of extremities, and application of pressure for 10 to 15 minutes are all good interventions after the factor is given.

A nurse instructs the parent of a child with sickle cell disease about factors that might precipitate a pain crisis in the child. Which of the following factors identified by the parent as being able to cause a pain crisis indicates a need for further instruction? 1. Infection. 2. Overhydration. 3. Stress at school. 4. Cold environment.

1. An infection can cause a child to go into crisis. *2. Overhydration does not cause a crisis. 3. Emotional stress can cause a child to go into crisis. 4. A cold environment causes vasoconstriction, which could lead to crisis. TEST-TAKING HINT: Because a sickle cell crisis may be precipitated by infection, dehydration, trauma, hypoxia, or stress, use the process of elimination to determine the need for further instruction.

Which of the following is the best method to prevent the spread of infection to an immunosuppressed child? 1. Administer antibiotics prophylactically to the child. 2. Have people wash their hands prior to contact with the child. 3. Assign the same nurses to care for the child each day. 4. Limit visitors to family members only.

1. Antibiotics should be used only if the child has a bacterial infection. *2. Hand washing is the best method to prevent the spread of germs and protect the child from infection. 3. All nurses should use the same techniques in caring for the child. Assigning the same nurses may not be possible. 4. Visitors should be screened for infection and communicable diseases, but visitors should not be limited to family members only. TEST-TAKING HINT: The first defense against infection is prevention. Strict hand-washing technique is a primary intervention to prevent the spread of infections. Review measures to protect the child from infection.

Which of the following is the most common opportunistic infection in children infected with human immunodeficiency virus (HIV)? 1. CMV. 2. Encephalitis. 3. Meningitis. 4. Pneumocystic pneumonia.

1. CMV infection is one commonly associated with HIV infections in children, but it is not the most common. 2. Encephalitis is not a specifi c opportunistic infection noted in HIV-infected children. 3. Meningitis is not a specifi c opportunistic infection noted in HIV-infected children. *4. Pneumocystis jiroveci pneumonia is the most common opportunistic infection that can occur in HIV-infected children, and such children are treated prophylactically for this. TEST-TAKING HINT: Note the words "most common" in the question.

The parent of a child diagnosed with Wilms tumor asks the nurse what the treatment plan will be. The nurse explains the usual protocol for this condition. Which information should the nurse give to the parent? 1. The child will have chemotherapy and, after that has been completed, radiation. 2. The child will need to have surgery to remove the tumor. 3. The child will go to surgery for removal of the tumor and the kidney and will then start chemotherapy. 4. The child will need radiation and later surgery to remove the tumor.

1. Chemotherapy is started after tumor removal, and radiation is done depending on stage and histological pattern. 2. Combination therapy of surgery and chemotherapy is the therapeutic management. *3. Combination therapy of surgery and chemotherapy is the primary therapeutic management. Radiation is done depending on clinical stage and histological pattern. 4. Radiation should be done after surgery and chemotherapy, depending on stage and histological pattern. TEST-TAKING HINT: Staging and biopsy determine the treatment, but the child will always have the tumor and kidney removed, followed by chemotherapy.

A 10-year-old with severe factor VIII deficiency falls, injures an elbow, and is brought to the ED. The nurse should prepare which of the following? 1. An IM injection of factor VIII. 2. An IV infusion of factor VIII. 3. An injection of desmopressin. 4. An IV infusion of platelets.

1. Factor VIII is not given intramuscularly. *2. The child is treated with an IV infusion of factor VIII to replace the missing factor and help stop the bleeding. 3. Desmopressin is given to stimulate factor VIII production, and it is given intravenously. 4. Platelets are not affected in hemophilia. TEST-TAKING HINT: Focus on the diagnosis of hemophilia: A deficiency in factor VIII causes continued bleeding with an injury.

A teen is seen in clinic for a possible diagnosis of Hodgkin disease. The nurse is aware that which of the following symptoms should make the health-care provider suspect Hodgkin disease? 1. Fever, fatigue, and pain in the joints. 2. Anorexia with weight loss. 3. Enlarged, painless, and movable lymph nodes in the cervical area. 4. Enlarged liver with jaundice.

1. Fever and pain may be some of the symptoms, but they can be caused by other forms of cancer. Joint pain is not a symptom of Hodgkin disease. 2. Anorexia with weight loss can be a symptom of many other conditions. *3. Enlarged, painless, and movable lymph nodes in the cervical area are the most common presenting manifestations of Hodgkin disease. 4. Enlarged liver with jaundice is not a presenting symptom with Hodgkin disease. TEST-TAKING HINT: Review the clinical manifestations of Hodgkin disease. Some of the manifestations are the same for many different cancers, so focus on the primary and most common manifestations.

The nurse is caring for a 10-year-old with leukemia who is receiving chemotherapy. The child is on neutropenic precautions. Friends of the child come to the desk and ask for a vase for the flowers they have brought with them. Which of the following is the best response? 1. "I will get you a special vase that we use on this unit." 2. "The flowers from your garden are beautiful but should not be placed in the room at this time." 3. "As soon as I can wash a vase, I will put the flowers in it and bring it to the room." 4. "Get rid of the flowers immediately. You could harm the child."

1. Flowers should not be kept in the room of the client who is neutropenic. There are no special vases that are used with these clients that can protect them from infection. *2. A neutropenic client should not have flowers in the room because the flowers may harbor Aspergillus or Pseudomonas aeruginosa. Neutropenic children are susceptible to infection. Precautions need to be taken so that the child does not come in contact with any potential sources of infection. Fresh fruits and vegetables can also harbor molds and should be avoided. Telling the friend that the flowers are beautiful but that the child cannot have them is a tactful way not to offend the friend. 3. Washing the vase will not change the reason for not having the flowers around the child. 4. This could scare the visitors and make them feel guilty that they might harm the child in some way TEST-TAKING HINT: Review neutropenic precautions; then by process of elimination determine that answers 1 and 3 are incorrect. Answer 4 is not a professional way of interacting with visitors.

The parent of a child with hemophilia is asking the nurse what caused the hemophilia. Which is the nurse ' s best response? 1. It is an X-linked dominant disorder. 2. It is an X-linked recessive disorder. 3. It is an autosomal dominant disorder. 4. It is an autosomal recessive disorder.

1. Hemophilia is transmitted as an X-linked recessive disorder. About 60% of children have a family history of hemophilia. The usual transmission is by a female with the trait and an unaffected male. *2. Hemophilia is transmitted as an X-linked recessive disorder. About 60% of children have a family history of hemophilia. The usual transmission is by a female with the trait and an unaffected male. 3. Hemophilia is transmitted as an X-linked recessive disorder. About 60% of children have a family history of hemophilia. The usual transmission is by a female with the trait and an unaffected male. 4. Hemophilia is transmitted as an X-linked recessive disorder. About 60% of children have a family history of hemophilia. The usual transmission is by a female with the trait and an unaffected male. TEST-TAKING HINT: The test taker needs to know how hemophilia is transmitted.

The most important reason health-care providers prescribe a combination of antiretroviral drugs to children with HIV is to delay: 1. Progression to AIDS. 2. Enable treatment of multiple symptoms. 3. Recurrence of symptoms. 4. Drug resistance.

1. Indirectly the use of multiple antiretroviral medications does minimize progression to a diagnosis of AIDS, but each of the drugs alone cannot control the progression. 2. The symptoms of HIV will be resolved once the antiretroviral therapy begins to decrease the viral load. 3. There is no way to predict if and when recurrence will occur. Taking antiretroviral medications and maintaining a healthy life style is the best way to decrease the risk of the symptoms. 4. A combination of antiretroviral medications is prescribed for a child who is HIV positive to delay development of drug resistance. HIV drugs work on different stages of the HIV life cycle to prevent reproduction of new virus particles. TEST-TAKING HINT: The importance of maintaining medications that assist in treatment and do not develop resistance is essential to controlling the virus.

The nurse is discharging a child who has just received chemotherapy for neuroblastoma. Which of the following statements made by the child ' s parent indicates a need for additional teaching? 1. "I will inspect the skin often for any lesions." 2. "I will do mouth care daily and monitor for any mouth sores." 3. "I will wash my hands before caring for my child." 4. "I will take a rectal temperature daily and report a temperature greater than 101°F (38.3°C) immediately to the health-care provider."

1. Inspecting the skin is a good measure to monitor for infection and should be done. 2. Mouth care is essential and should be done daily to help prevent infection. Chemotherapy puts the child at risk for mucositis. 3. Washing the hands is one of the most important measures to prevent infection. *4. Monitoring the child ' s temperature and reporting it to the physician are important, but the temperature should not be taken rectally. The risk of injury to the mucous membranes is high. Rectal abscesses can occur in the damaged rectal tissue. The best method for taking the temperature is axillary, especially if the child has mouth sores. TEST-TAKING HINT: Review home-care instructions for children who have just received chemotherapy. These are measures to protect the child from infection and to monitor for infection.

A child with leukemia is receiving chemotherapy and is complaining of nausea. The nurse has been giving the scheduled antiemetic. Which of the following should the nurse do when the child is nauseated? 1. Encourage low-protein foods. 2. Encourage low-caloric foods. 3. Offer the child ' s favorite foods. 4. Offer cool, clear liquids.

1. It is better to provide high-protein nutritional supplements if the child can tolerate them. 2. It is better to provide high-caloric nutritional supplements. 3. Offering the child ' s favorite foods when the child is nauseated can create a later association with being sick; then the child may not want that food when not ill. *4. Cool, clear liquids are better tolerated. Milk-based products cause secretions to be thick and can cause vomiting. TEST-TAKING HINT: With nausea and vomiting, it is important to consider nutritional status. Answers 1 and 2 do not improve nutrition. Supportive nutritional supplements should be offered. Review measures to prevent nausea and provide nutrition.

The nurse is caring for a child who is receiving extensive radiation as part of the treatment for Hodgkin disease. Which intervention should be implemented? 1. Administer pain medication prior to the child ' s going to radiation therapy. 2. Assess the child for neuropathy since this is a common side effect. 3. Provide adequate rest, because the child may experience excessive malaise and lack of energy. 4. Encourage the child to eat a low-protein diet while on radiation therapy.

1. It should not be necessary to give pain medication, because radiation therapy should not be painful. 2. Neuropathy is not a normal side effect of radiation therapy. *3. The most common side effect is extensive malaise, which may be from damage to the thyroid gland, causing hypothyroidism. 4. No diet restriction is required for the radiation therapy. Continue with nutritional supplements as needed to maintain adequate nutrition. TEST-TAKING HINT: Review the side effects of radiation therapy. Lack of energy may be difficult emotionally in adolescents, because they want to keep up with their peers.

The parent of a 4-year-old brings the child to the clinic and tells the nurse the child ' s abdomen is distended. After a complete examination, a diagnosis of Wilms tumor is suspected. Which of the following is most important when doing a physical examination on this child? 1. Avoid palpation of the abdomen. 2. Assess the urine for the presence of blood. 3. Monitor vital signs, especially the blood pressure. 4. Obtain an accurate height and weight.

1. Palpating the abdomen of the child in whom a diagnosis of Wilms tumor is suspected should be avoided because manipulation of the abdomen may cause seeding of the tumor. 2. Hematuria is a clinical manifestation. 3. Because the kidney is involved, hypertension should be assessed. 4. Height and weight are always important to obtain, because they can be used to calculate doses of medications and chemotherapy. TEST-TAKING HINT: All of the assessment data are important, but the key phrase is "most important." Seeding of the tumor could spread cancerous cells.

Which of the following will be abnormal in a child with the diagnosis of hemophilia? 1. Platelet count. 2. Hemoglobin level. 3. White blood cell count. 4. Partial thromboplastin time (PTT).

1. Platelet function is normal in hemophilia. 2. There is no change in hemoglobin with a diagnosis of hemophilia. The hemoglobin will drop with bleeding. 3. The white blood cell count does not change with hemophilia. *4. The abnormal laboratory results in hemophilia are related to decreased clotting function. Partial thromboplastin time is prolonged. TEST-TAKING HINT: Use the process of elimination to determine the test that indicates a decrease in clotting.

Prednisone is given to children who are being treated for leukemia. Why is this medication given as part of the treatment plan? 1. Enhances protein metabolism. 2. Enhances sodium excretion. 3. Increases absorption of the chemotherapy. 4. Destroys abnormal lymphocytes.

1. Prednisone does not enhance protein metabolism. 2. Prednisone may cause retention of sodium. 3. There is no drug that increases absorption of chemotherapy. *4. Prednisone is used in many of the treatment protocols for leukemia because there is abnormal lymphocyte production. Prednisone is thought to destroy abnormal lymphocytes. TEST-TAKING HINT: Prednisone is given in conjunction with chemotherapy. It helps modify the body ' s immune response.

The nurse expects which of the following clinical manifestations in a child diagnosed with SCID? 1. Prolonged bleeding. 2. Failure to thrive. 3. Fatigue and malaise. 4. Susceptibility to infection.

1. Prolonged bleeding indicates abnormalities of the clotting system. 2. Failure to thrive is a consequence of a present illness. 3. Fatigue and malaise result from decreases in red blood cells. *4. SCID is characterized by an absence of cell-mediated immunity, with the most common clinical manifestation being infection in children from age 3 months. These children do not usually recover from these infections. TEST-TAKING HINT: Review the clinical manifestations of SCID, keeping in mind that the word "immunodefi ciency" should indicate infection, which is the key to getting the correct answer.

Which of the following should be done to protect the central nervous system from the invasion of malignant cells in a child newly diagnosed with leukemia? 1. Cranial and spinal radiation. 2. Intravenous steroid therapy. 3. Intrathecal chemotherapy. 4. High-dose intravenous chemotherapy.

1. Radiation should be done as part of therapy if there is metastasis. 2. Steroids are given as part of the treatment protocol but do not need to be given intravenously. Steroids do not pass through the blood-brain barrier. *3. Giving chemotherapy via lumbar puncture allows the drugs to get to the brain and helps prevent metastasis of the disease. 4. Chemotherapy that is given intravenously will not pass through the blood-brain barrier. TEST-TAKING HINT: Oral and IV chemotherapies do not pass through the blood-brain barrier. Intrathecal chemotherapy needs to be done to protect the central nervous system from metastasis of the disease.

Which of the following laboratory tests will be ordered to determine the presence of the human immunodeficiency virus antigen in an infant whose mother is HIV + ? 1. CD4 cell count. 2. Western blot. 3. IgG levels. 4. p24 antigen assay.

1. The CD4 cell count indicates how well the immune system is working. 2. A Western blot test confirms the presence of HIV antibodies. 3. An IgG level samples the immune system. *4. Detection of HIV in infants is confirmed by a p24 antigen assay, viral culture of HIV, or polymerase chain reaction. TEST-TAKING HINT: Review the laboratory tests for HIV-infected clients. The important word in the question is "infant."

The nurse is caring for a child with sickle cell disease who is scheduled to have a splenectomy. What information should the nurse explain to the parents regarding the reason for a splenectomy? 1. To decrease potential for infection. 2. To prevent splenic sequestration. 3. To prevent sickling of red blood cells. 4. To prevent sickle cell crisis.

1. The cells involved with sickle cell disease are abnormal red blood cells, which do not decrease infections. 2. Splenic sequestration is a life-threatening situation in children with sickle cell disease. Once a child is considered to be at high risk of splenic sequestration or has had this in the past, the spleen will be removed. 3. Removal of the spleen will not prevent sickling, because it will not change the disease condition. 4. The child will still have sickle cell disease and can still have sickle cell crises. TEST-TAKING HINT: Review splenic sequestration and when a child can go into sickle cell crisis.

The parent of a 2-year-old who is HIV + questions the nurse about placing the child in day care. Which of the following is the best response? 1. The child should not go to day care until older, because there is a high risk for transmission of the disease. 2. The child can go to day care without restrictions and should be allowed to participate in all activities. 3. The child can go to day care but should avoid physical activity. 4. The child may go to day care, but the parent must inform all the parents at the day care that the child is HIV + .

1. The child can attend day care. The risk of transmission remains the same at any age. *2. The child can attend day care without any limitations but should not attend with a fever. 3. There is no need to restrict the child ' s activity. 4. There is no law that requires notification of the child ' s condition. TEST-TAKING HINT: Review the modes of transmission of HIV infection in children. The day-care facility should practice universal precautions when caring for all its children.

What are the clinical manifestations of non-Hodgkin lymphoma? 1. Basically the same as those in Hodgkin disease. 2. Depends on the anatomical site and extent of involvement. 3. Nausea, vomiting, abdominal pain. 4. Behavior changes, jaundice, dry mouth.

1. The clinical manifestations are different from those of Hodgkin disease, because the enlarged lymph nodes usually occur in the cervical area. *2. The clinical manifestations include symptoms of involvement. Rarely is a single sign or symptom diagnostic. Metastasis to the bone marrow or central nervous system may produce manifestations of leukemia. 3. The manifestations are not just limited to the abdomen, and NHL is not usually seen in young children. 4. Behavior changes, jaundice or dry mouth are not presenting signs of NHL. TEST-TAKING HINT: Review the difference between Hodgkin disease and non-Hodgkin lymphoma.

When caring for a child with lymphoma, the nurse needs to be aware of which of the following? 1. The same staging system is used for lymphoma and Hodgkin disease. 2. Aggressive chemotherapy with central nervous system prophylaxis will give the child a good prognosis. 3. All children with lymphoma need a bone marrow transplant for a good prognosis. 4. Despite high-dose chemotherapy, the prognosis is very poor for most children.

1. The clinical staging system used in Hodgkin disease is of little value in lymphoma. Other systems have been developed. *2. The use of aggressive combination chemotherapy has a major impact on the survival rates for children with a diagnosis of lymphoma. Because there is usually bone marrow involvement, there is a need for central nervous system prophylaxis. 3. Not all children receive a bone marrow transplant. 4. Usually there is a good prognosis for lymphoma with aggressive chemotherapy. TEST-TAKING HINT: Be careful not to answer a question with a response that has the word "all" in it, because rarely will something always occur.

A nurse is doing discharge education with a parent who has a child with betathalassemia (Cooley anemia). The nurse informs the parent that the child is at risk for which of the following conditions? 1. Hypertrophy of the thyroid. 2. Polycythemia vera. 3. Thrombocytopenia. 4. Chronic hypoxia and iron overload.

1. The thyroid is not involved in beta-thalassemia. 2. Polycythemia vera is excessive red blood cell production, which can result in thrombosis. 3. There is no increase in platelets in beta-thalassemia. *4. In beta-thalassemia, there is increased destruction of red blood cells, causing anemia. This results in chronic anemia and hypoxia. The children are treated with multiple blood transfusions, which can cause iron overload and damage to major organs. TEST-TAKING HINT: Focus on the pathophysiology of the disease. Then, by process of elimination, the effect of the disease on the body can be identified.

A child has completed treatment for leukemia and comes to the clinic for a checkup with the parents. The parents express to the nurse that they are glad their child has been cured of cancer and is safe from getting cancer later in life. Which of the following should the nurse consider in responding? 1. Childhood cancer usually instills immunity to all other cancers. 2. Children surviving one cancer are at higher risk for a second cancer. 3. The child may have a remission of the leukemia but is immune to all other cancers. 4. As long as the child continues to take steroids, there will be no other cancers.

1. There is no immunity to recurrent cancers with remission of the leukemia. *2. The most devastating late effect of leukemia treatment is development of secondary malignancy. 3. After the child is in remission, the child may relapse, but there is no immunity to other malignancy. 4. The child will not receive steroid treatment after completing therapy. TEST-TAKING HINT: Review late effects of treatment of childhood cancer. This should include chemotherapy as well as radiation treatments.

Which intervention should be implemented after a bone marrow aspiration? 1. Ask the child to remain in a supine position. 2. Place the child in an upright position for 4 hours. 3. Keep the child nothing by mouth for 6 hours. 4. Administer analgesics as needed for pain.

1. There is no need to have the client remain supine after a bone marrow aspiration is done. 2. The child can assume any position after a bone marrow aspiration. 3. The child usually receives conscious sedation during the procedure and will have nothing by mouth prior to the procedure. Oral fl uids can be resumed after the procedure is completed. *4. Children may experience minor discomfort after the procedure, and analgesics should be given as needed. TEST-TAKING HINT: Review the procedure for doing a bone marrow aspiration and be aware of nursing care after the procedure. There should be no reason for the child to be in a specific position or to have fluids withheld after the procedure. Managing pain is always a priority need.

Where is the primary site of origin of the tumor in children who have neuroblastoma? 1. Bone. 2. Kidney. 3. Abdomen. 4. Liver.

1. Tumor involvement in the bone is usually osteosarcoma. 2. Tumors that are located in the kidney are most often a Wilms tumor. *3. Neuroblastoma tumors originate from embryonic neural crest cells that normally give rise to the adrenal medulla and the sympathetic nervous system. The majority of the tumors arise from the adrenal gland or from the retroperitoneal sympathetic chain. Therefore, the primary site is within the abdomen. 4. In most tumors in children, there is liver involvement when there is metastasis to the liver. TEST-TAKING HINT: Review the origin of neuroblastoma to determine the tumor sites.

Which of the following describes idiopathic thrombocytopenia purpura (ITP)? Select all that apply. 1. ITP is a congenital hematological disorder. 2. ITP causes excessive destruction of platelets. 3. Children with ITP have normal bone marrow. 4. Platelets are small in ITP. 5. Purpura is observed in ITP.

2, 3, 5. 1. ITP is an acquired hematological condition that is characterized by excessive destruction of platelets, purpura, and normal bone marrow along with an increase in large, yellow platelets. 2. ITP is characterized by excessive destruction of platelets. 3. The bone marrow is normal in children with ITP. 4. Platelets are large, not small. 5. ITP is characterized by purpura, which are areas of hemorrhage under the skin. TEST-TAKING HINT: Review the pathophysiology of ITP to determine the manifestations of the disease.

The nurse receives a call from a parent of a child with leukemia in remission. The parent says the child has been exposed to chickenpox and has never had it. Which of the following responses is most appropriate for the nurse? Select all that apply. 1. "You need to monitor the child ' s temperature frequently and call back if the temperature is greater than 101°F (38.3°C)." 2. "The child has had two varicella immunizations as an infant but is no longer immune after chemotherapy." 3. "You need to bring the child to the clinic for a varicella immunoglobulin vaccine." 4. "Your child will need to be isolated for the next 2 weeks." 5. "Your child may develop chicken pox lesions about 14 to 21 days after exposure."

2, 3. 1. The temperature should always be monitored, but the child has been exposed to chickenpox. The child needs to be protected from getting the disease as it can be life threatening. 2. Chickenpox exposure is a real concern for a child who is immunocompromised, and action needs to be taken. 3. The child should receive varicella zoster immune globulin within 96 hours of the exposure. 4. Starting isolation at this time does not protect the child. 5. If the parent acts immediately and the child receives IVIG, the child will not develop the lesions of chicken pox. TEST-TAKING HINT: Review protective precautions that should be taken for immunocompromised children. Chickenpox can be deadly for these children.

Which of the following is a reason to perform a lumbar puncture on a child with a diagnosis of leukemia? Select all that apply. 1. Rule out meningitis. 2. Assess the central nervous system for infi ltration. 3. Give intrathecal chemotherapy. 4. Determine increased intracranial pressure. 5. Stage the leukemia.

2, 3. 1. There is no need to perform a spinal tap to rule out meningitis unless the patient has symptoms of meningitis. 2. A lumbar puncture is done to determine whether the cancer cells have entered the CNS, but this would not be routine unless the child was symptomatic. 3. Chemotherapy can also be given through a lumbar puncture (spinal tap). 4. ICP would be considered if the child had symptoms of headache, nausea, forceful vomiting, blurred or double vision, drowsiness, or seizure; an LP might then be performed. 5. Leukemia is not staged. TEST-TAKING HINT: The primary site for leukemia involvement is the bone marrow. Rarely do children have CNS involvement.

Which of the following should the nurse expect to administer to a child with ITP and a platelet count of 5000/mm 3 ? Select all that apply. 1. Platelets. 2. Intravenous immunoglobulin. 3. Packed red blood cells (PRBCs). 4. White blood cells. 5. Prednisolone.

2, 5. 1. In ITP, destruction of platelets is caused from what is believed to be an immune response, so giving additional platelets would only result in new platelets being destroyed. 2. Intravenous immunoglobulin is given because the cause of platelet destruction is believed to be an autoimmune response to disease-related antigens. Treatment is usually supportive. Activity is restricted at the onset because of the low platelet count and risk for injury that could cause bleeding. 3. Red blood cells are not an effective treatment for ITP. 4. Because this is a platelet deficiency, white blood cells are not an effective treatment for ITP. White blood cell infusion is rarely done with any disease process. 5. Treatment in the acute phase is often symptomatic, and prednisolone, IVIG, and anti-D antibody are often given. This tends to shorten the course because the disease tends to resolve over time. Focus on the cause of ITP and which cells are affected.

The nurse is caring for a child diagnosed with thalassemia major who is receiving the first chelation therapy. What information should the nurse provide to the parent regarding the therapy? Select all that apply. 1. Decreases the risk of bleeding. 2. Eliminates excess iron. 3. Prevents further sickling of the red blood cells. 4. Provides an iron supplement. 5. Hydration is necessary for the process to be effective.

2, 5. 1. There are no bleeding tendencies in thalassemia major (beta-thalassemia or Cooley anemia), and chelation does not affect clotting. 2. Chelation therapy is used to rid the body of excess iron stores that result from frequent blood transfusions. 3. There is no sickling of red blood cells in thalassemia, and chelation therapy has no direct effect on red blood cells. 4. Chelation does not provide an iron supplement. *5. Hydration is necessary for the process to be effective. TEST-TAKING HINT: Focus on the treatment of beta-thalassemia and how chelation therapy works.

A nurse is caring for a 5-year-old with sickle cell vaso-occlusive crisis. Which of the following orders should the nurse question? Select all that apply. 1. Position the child for comfort. 2. Apply hot packs to painful areas. 3. Give meperidine (Demerol) 25 mg intravenously every 4 hours as needed for pain. 4. Restrict oral fluids. 5. Apply oxygen per nasal cannula to keep oxygen saturations above 94%.

3, 4, 5. 1. Medical treatment of sickle cell vasoocclusive crises is directed toward preventing hypoxia. Tissue hypoxia is very painful, so placing the child in a position of comfort is important. 2. Hot packs help relieve pain because they cause vasodilation, which allows increased blood fl ow and decreased hypoxia. 3. Tissue hypoxia is very painful. Narcotics such as morphine are usually given for pain when the child is in a crisis. Meperidine (Demerol) should be avoided because of the risk of Demerol-induced seizures. 4. The child should receive hydration because when the child is in crisis, the abnormal S-shaped red blood cells clump, causing tissue hypoxia and pain. 5. Oxygen is of little value unless the tissue is hypoxic. The objective of treatment is to minimize hypoxia. TEST-TAKING HINT: Focus on the pathophysiology of a vaso-occlusive crisis. Keep in mind measures that decrease tissue hypoxia.

Which of the following is the most effective treatment for pain in a child with sickle cell crisis? Select all that apply. 1. Meperidine (Demerol). 2. Aspirin. 3. Morphine. 4. Behavioral techniques. 5. Acetaminophen (Tylenol) with codeine.

3, 4, 5. 1. Meperidine (Demerol) should not be used because it may potentiate seizures. 2. Aspirin should not be used in children because of the risk for Reye syndrome. 3. Morphine is the drug of choice for a child with sickle cell crises. Usually the child is started on oral doses of acetaminophen (Tylenol) with codeine. When that is not sufficient to alleviate pain, stronger narcotics are prescribed, such as morphine. Ketorolac (Toradol) may be indicated for short-term use for moderate-severe pain. 4. Behavioral techniques such as positive self-talk, relaxation, distraction, and guided imagery are helpful when pain is occurring. 5. Usually the child is started on oral doses of acetaminophen (Tylenol) with codeine when pain is described as mild to moderate. TEST-TAKING HINT: One needs to consider using narcotics when a child has sickle cell crises, because tissue hypoxia can cause severe pain.

An 18-month-old male is brought to the clinic by his mother. His height is in the 50th percentile, and his weight is in the 80th percentile. The child is pale. The physical examination is normal, but his hematocrit level is 20%. Which of the following questions should assist the nurse in making a diagnosis? Select all that apply. 1. "How many bowel movements a day does your child have?" 2. "How much did your baby weigh at birth?" 3. "What does your child eat every day?" 4. "Has the child been given any new medications?" 5. "How much milk does your child drink per day?"

3, 5. 1. Because the child has a low hematocrit level, the child most likely has anemia. Iron-deficiency anemia is the most common nutritional anemia. The number of bowel movements the child has is important information but not necessary to make the diagnosis of iron-deficiency anemia. 2. Knowing birth weight can help determine whether the child is following his or her own curve on the growth chart. 3. A diet history is necessary to determine the nutritional status of the child and whether the child is getting sufficient sources of iron. 4. Knowing if the child is taking any new medication is not necessary to make the diagnosis of iron-deficiency anemia. 5. By asking how much milk the child consumes, the nurse can determine whether the child is filling up on milk and then not wanting to take food. TEST-TAKING HINT: The most common anemia in children and in toddlers is iron deficiency anemia, frequently the result of drinking too much milk and not eating enough iron-rich foods.

The nurse is taking care of a child with sickle cell disease. The nurse is aware that which of the following problems is (are) associated with sickle cell disease? Select all that apply. 1. Polycythemia. 2. Hemarthrosis. 3. Aplastic crisis. 4. Thrombocytopenia. 5. Vaso-occlusive crisis.

3, 5. 1. Polycythemia is seen in children with chronic hypoxia, such as cyanotic heart disease. 2. Hemarthrosis, bleeding into a joint, is commonly seen in children with hemophilia. 3. Aplastic crisis, temporary cessation of red blood cell production, is associated with sickle cell anemia. 4. Thrombocytopenia is associated with idiopathic thrombocytopenia purpura, high altitude, medication side effects, and pregnancy. 5. Vaso-occlusive crisis is the most common problem in children with sickle cell disease. TEST-TAKING HINT: Defining the terms will make the correct responses evident.

The nurse is instructing the parent of a child with HIV about immunizations. Which of the following should the nurse tell the parent? Select all that apply. 1. Hepatitis B vaccine will not be given to this child. 2. Members of the family should be cautioned not to receive the varicella vaccine. 3. The child will need to have a Western blot test done prior to all immunizations. 4. Pneumococcal and influenza vaccines are recommended. 5. Meningitis immunization.

4, 5. 1. Hepatitis B vaccine is administered according to the immunization schedule. 2. The varicella vaccine is avoided in the child who is HIV-infected, not in the other members of the family. 3. A Western blot test is not done and is not necessary. 4. Immunizations against childhood illnesses are recommended for children exposed to or infected with HIV. Pneumococcal and influenza vaccines are recommended at their scheduled times. 5. Meningococcal immunizations can be administered on the regular schedule. TEST-TAKING HINT: Review the immunization schedule, keeping in mind that HIV-infected children should not receive live viruses.