Peds Chapter 46
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."
A nurse is providing dietary interventions for a 5-year-old with an iron deficiency. Which response indicates a need for further teaching?
"Red meat is a good option; he loves the hamburgers from the drive-thru."
The nurse caring for a 14-year-old scheduled for magnetic resonance imaging (MRI) explains to a family how the test works. Which response accurately describes this test?
"The MRI uses radio waves and magnets to produce a computerized image of the body."
The nurse is caring for a 14-year-old client scheduled for magnetic resonance imaging (MRI). The nurse explains the test to the child and family. Which information would be most appropriate to include in the explanation?
"The MRI uses radio waves and magnets to produce a computerized image of the body."
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 and the child usually experiences minimal neurologic deficits post-operatively."
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?
"The prognosis is favorable with complete surgical resection, with minimal neurologic deficits postoperatively."
The nurse must calculate the absolute neutrophil count (ANC) for an immunosuppressed child. Which is the accurate ANC based on the following laboratory results? Total white blood cell count (WBC): 3000. WBC differential: 10% segmented neutrophils, 8% neutrophil bands.
540
A client with cancer is diagnosed with typhlitis. Which emergency intervention would the nurse perform?
Administer broad-spectrum antibiotics intravenously.
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:
Allogeneic
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?
Apply heat to the site of bleeding.
How can the nurse most simply describe for distressed parents a rhabdomyosarcoma that has been found in their 5-year-old?
Call it a tumor of muscle tissue
Individuals with hemophilia B have a deficiency in factor IX, which can cause excessive blood loss. What is another name for this clotting factor?
Christmas factor
The nurse is assessing an 11-year-old child diagnosed with acute myeloid leukemia (AML) who came to the emergency department. What would alert the nurse to the need for immediate intervention?
Complete blood count (CBC) indicates hyperleukocytosis.
Which diagnosis would be most appropriate for an infant with a large retinoblastoma after surgery?
Disturbed sensory perception related to enucleation
The pediatric nurse reviews the radiographs of a child and observes that there are lesions on the bone. The nurse interprets this finding as suggesting which condition?
Ewing sarcoma
The pediatric nurse examines the radiographs of a client that indicate lesions on the bone. This finding is indicative of:
Ewing sarcoma.
While administering a blood transfusion to a child with a hematologic disorder, the nurse notes the child develops urticaria and wheezing. Which collaborative interventions will the nurse begin? Select all that apply.
Give an antihistamine. Apply oxygen as needed. Discontinue the transfusion.
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.
The nurse treating clients with hemophilia knows that if bleeding is not treated effectively, which body part is at greatest risk for the development of chronic, disabling disease?
Joints
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
A child with sickle cell disease is brought to the emergency department by his parents. He is in excruciating pain. A vaso-occlusive crisis is suspected and analgesia is prescribed. What would the nurse expect as least likely to be ordered?
Meperidine
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 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.
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.
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
The health care provider prescribes an alkylating agent as part of a child's chemotherapy regimen. When explaining this classification of drug to the child and parents, which information would the nurse integrate into the explanation?
They are cell cycle-nonspecific, destroying both resting and dividing cells.
A nurse is providing care for a child with disseminated intravascular coagulation (DIC). What would alert the nurse to possible neurologic compromise?
Widely fluctuating blood pressure
The nurse will select which meal as the best choice for a child with iron-deficiency anemia?
cheeseburger, broccoli, and fresh strawberries
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
The nurse is providing care for a 13-year-old child diagnosed with iron-deficiency anemia. The client's current hemoglobin level is 11 g/dL (110 g/L). Which intervention will the nurse anticipate including in the client's care?
giving ferrous sulfate with orange juice between meals
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:
induction.
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.
A 5-year-old child is at the pediatric clinic for a well-child visit. Which symptom alerts the health care provider that this child might have acute lymphoblastic leukemia (ALL)?
lethargy, bruises, and lymphadenopathy
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:
neuroblastoma.
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 child has been diagnosed with leukemia. Rank the following medications used to treat leukemia in order based on the stage of treatment.
oral steroids and vincristine through an intravenous line high-dose methotrexate and 6-mercaptopurine low doses of 6-mercaptopurine and methotrexate chemotherapy through an intrathecal catheter
The nurse is assessing a school-aged child with sickle-cell anemia. Which assessment finding is consistent with this child's diagnosis?
slightly yellow sclera
The nurse is teaching the parents of a 15-year-old boy who is being treated for acute myeloid leukemia about the side effects of chemotherapy. For which symptoms should the parents seek medical care immediately?
temperature of 101°F (38.3°C) or greater
After teaching a group of students about hemophilia, the instructor determines that the students have understood the information when they identify hemophilia A as involving a problem with:
factor VIII.
The nurse is caring for a 4-year-old child following surgical removal of a stage I neuroblastoma. Which intervention is appropriate for this child?
giving medications as prescribed via the least invasive route
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?
fever with no response to repeated antibiotics
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
When reviewing information about the incidence of the various types of childhood cancer, nursing students demonstrate understanding of the information when they identify which type as having the highest incidence?
Acute lymphoblastic leukemia (ALL)
The nurse is caring for clients receiving anticoagulant therapy for embolism prevention. Which factors are a part of the intrinsic pathway for coagulation? Select all that apply.
Antihemophilic factor Christmas factor Hageman factor
The nurse is providing preoperative care for a 7-year-old boy with a brain tumor, as well as his parents. Which intervention is a priority?
Assessing the child's level of consciousness.
The nurse is assessing an adolescent with suspected osteosarcoma. What would the nurse be least likely to assess?
Severe bone pain
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.
A child with hypoplastic anemia develops hemosiderosis. The therapy for this is:
deferoxamine.
A pediatric nurse is conducting a class for a group of nursing students about children with cancer. The nurse determines that the teaching was successful when the class identifies which as reflecting typical signs of pediatric cancers? Select all that apply.
pain related to compression, infiltration, or obstruction caused by the tumor secretion of a substance by the tumor that interferes with normal organ function Alterations caused by tumor metabolism or cell death
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?
10 mg
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 nurse explains to the teenager that which alterations may occur when steroids are added to the cancer therapy regimen?
Facial changes
A toddler who is beginning to walk has fallen and hit his head on the corner of a low table. The caregiver has been unable to stop the bleeding and brings the child to the pediatric clinic. The nurse is gathering data during the admission process and notes several bruises and swollen joints. A diagnosis of hemophilia is confirmed. This child most likely has a deficiency of which blood factor?
Factor VIII
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.
The nurse is teaching a group of 13-year-old boys and girls about screening and prevention of reproductive cancers. Which subjects would be included in the nurse's teaching plan? Select all that apply.
Self-examination is an effective screening method for testicular cancer. A Papanicolaou test does not require parent consent in most states. Sexually transmitted infections are a risk factor for cervical cancer. Provide information regarding the benefits of receiving the human papillomavirus (HPV) vaccine.
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.
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?
complete blood count and iron level
A nurse is caring for a child diagnosed with von Willebrand disease who is receiving desmopressin as part of the treatment regimen. In relation to desmopressin administration, what assessment finding(s) is important for the nurse to monitor? Select all that apply.
electrolyte balance intake/output heart rate
The nurse is assessing a child in the pediatric intensive care unit. Which assessment finding(s) warrants immediate action? Select all that apply.
increased D-dimer assay petechiae persistent oozing from venipuncture site
After teaching the parents of a child diagnosed with sickle cell disease, the nurse determines that the teaching was successful when the parents state that they will contact the primary health care provider if the child develops which signs or symptoms? Select all that apply.
chest pain severe dizziness sudden change in vision
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.
Antiemetics are prescribed to control nausea and vomiting in the child undergoing chemotherapy. How can the nurse most effectively use these medications?
Administer the antiemetic before starting chemotherapy.
