quiz 1, NURS 405 prep
The nurse is assisting the client with multiple myeloma to ambulate. What is the most important nursing intervention to help prevent fractures in the client? Encourage adequate nutrition. Provide adequate hydration. Promote safety. Increase mobility.
Promote safety.
The nurse is reviewing the long-term treatment plan with a client diagnosed with Hodgkin lymphoma. Which recommendations will the nurse provide to reduce the client's risk of developing secondary malignancies? Select all that apply. Restrict use of tobacco. Reduce intake of alcohol. Avoid foods high in carbohydrates. Limit the intake of citrus fruits. Avoid excessive sunlight.
Restrict use of tobacco Reduce intake of alcohol Avoid excessive sunlight
When planning the care for a child with leukemia who is receiving methotrexate, the nurse would assess the child closely for which possible effect? paresthesias of the fingers mucositis weight gain cushingoid facial appearance
mucositis Explanation: Mucositis, or ulcers of the gum line and mucous membranes of the mouth, is a frequent side effect of methotrexate. Cushingoid facial appearance and weight gain are associated with the use of prednisone. Paresthesias are associated with vincristine.
The nurse is discussing disorders of the hematopoietic system when a client asked about erythrocytosis. What disease will the nurse mention with a primary characteristic of erythrocytosis? polycythemia vera sickle cell disease aplastic anemia pernicious anemia
polycythemia vera
The nursing instructor is discussing disorders of the hematopoietic system with the pre-nursing pathophysiology class. What disease would the instructor list with a primary characteristic of erythrocytosis? Polycythemia vera Sickle cell disease Aplastic anemia Pernicious anemia
polycythemia vera
The 2-year-old child receiving treatment for a cancer diagnosis is seen for a well-child checkup. Which health maintenance activity will the nurse exclude? assessing dietary intake by addressing "picky eating" and "food jags" plotting height and weight on a growth chart administering the measles, mumps, rubella (MMR) vaccine teaching the importance of taking water safety measures
administering the measles, mumps, rubella (MMR) vaccine Explanation: Live vaccines (viral or bacterial) should not be administered to an immunosuppressed child because of the risk of causing disease. The other health maintenance activities are important for the health maintenance of the child and should be included during the well-child visit.
A client is being tested for acute myeloid leukemia (AML). The nurse knows that which diagnostic test will be used as the hallmark for the diagnosis? Complete blood count Clotting factors Bone marrow analysis Alkaline phosphatase level
Bone marrow analysis
A client with acute myeloid leukemia has a fever. What pathophysiological process does the nurse recognize is the cause of the client's fever? Neutropenia Pancytopenia Anemia Thrombocytopenia
Neutropenia
What assessment finding best indicates that the client has recovered from induction therapy? Neutrophil and platelet counts within normal limits Vital signs within normal ranges No evidence of edema Absence of bone pain
Neutrophil and platelet counts within normal limits
The nurse is planning care for a child with idiopathic thrombocytopenic purpura. Which client education should be included? Not to pick or irritate the nose To use mainly cold water to wash What foods are high in folic acid To apply a soothing cream to lesions
Not to pick or irritate the nose Explanation: Idiopathic thrombocytopenic purpura (ITP) occurs as an immune response following a viral infection. It produces antiplatelet antibodies that destroy platelets. This leads to the classic symptoms of petechiae, purpura, and excessive bruising. Without adequate platelets, children bleed easily from lesions. If the child "picks" the nose, an area could be opened and bleeding could occur. Folic acid will have no effect on the disease process. The lesions are not itchy and are open or draining, so cold water washing and soothing lotions are not required.
Which term refers to an abnormal decrease in white blood cells, red blood cells, and platelets? Pancytopenia Leukopenia Thrombocytopenia Anemia
Pancytopenia
A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see? Hypermagnesemia Hypercalcemia Hypernatremia Hyperkalemia
Hypercalcemia
The nurse is caring for a 10-year-old girl with iron toxicity. What would the nurse expect the physician to order? Edetate calcium disodium Dimercaprol Succimer Deferasirox
Deferasirox Explanation: Deferasirox is indicated for iron toxicity. It binds with iron, which is removed via the kidneys. Dimercaprol is indicated for blood lead levels greater than 45 mcg/dl. It removes lead from soft tissues and bone, allowing for its excretion via the renal system. Edetate calcium disodium is indicated for blood lead levels greater than 45 mcg/dl. The medication removes lead from soft tissues and bone, allowing for its excretion via the renal system. Succimer is indicated for blood lead levels greater than 45 mcg/dl; it removes lead from soft tissues and bone, allowing for its excretion via the renal system.
A nurse is assisting with a bone marrow aspiration and biopsy for a 6-year-old child. Which would be most important? Placing a folded blanket or pillow under the head to raise it. Using aseptic technique for the procedure. Asking the parents to leave the room for the procedure. Positioning the child on the side.
Using aseptic technique for the procedure. Explanation: The procedure is done using aseptic technique. The child is positioned based on the site of aspiration and a folded blanket or pillow is placed under the abdomen to elevate the hips. Parents should be allowed to stay in the room for emotional support.
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 Hematuria Equal pupillary response Petechiae
Widely fluctuating blood pressure Explanation: A key aspect of the nurse's role is to assess the child for signs and symptoms of impaired tissue perfusion in the various body systems that may be affected by DIC. Unstable or abnormal blood pressure (such as wide BP fluctuations) or unequal pupil size may suggest neurologic compromise. Hematuria would suggest renal compromise. Petechiae would be indicative of bleeding into the skin.
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? monitoring his vital signs every 4 hours restricting visitors with symptoms of infection administering prescribed broad-spectrum IV antibiotics assessing for signs of infection every 8 hours
administering prescribed broad-spectrum IV antibiotics Explanation: The priority intervention for this child is administering prescribed broad-spectrum IV antibiotics. His absolute neutrophil count (ANC; calculated by adding the bands and segs [21%] and then multiplying this [0.20] by the white blood cell count [2540] to yield an ANC of 508) indicates he has neutropenia and his temperature indicates he may have an infection. Monitoring vital signs, restricting visitors with symptoms of infection, and assessing for signs of infection are valid interventions related to neutropenia but are of lesser importance at this point.
Which mechanism is central to cancers in children? genetics race environment cellular growth
cellular growth Explanation: Certain pediatric malignancies clearly occur at times of peak physical growth and cellular maturation. This coincidence suggests that cellular growth and development are central to the mechanism of cancer in children. By contrast, environmental exposures are a primary component of carcinogenesis in adults. Genetics and race are not commonly identified as related to pediatric cancers.
A nurse is caring for a child diagnosed with medulloblastoma. Which would the nurse expect to include as part of the child's plan of treatment? Select all that apply. radiation therapy Use of preoperative anticonvulsant therapy chemotherapy in high-risk cases use of biologic response modifiers complete surgical resection
complete surgical resection radiation therapy chemotherapy in high-risk cases
A client has been diagnosed with multiple myeloma. Which of the following laboratory values should the nurse expect to find in a client with multiple myeloma? Decreased calcium level Decreased serum protein Polycythemia vera Increased urinary protein
increased urinary protein
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? sanctuary stage delayed intensive-therapy stage induction stage consolidation stage
induction stage Explanation: A chemotherapy program is first aimed at achieving a complete remission or absence of leukemia cells (induction phase); second, preventing leukemia cells from invading or growing in the CNS (sanctuary or consolidation phase); third, administering delayed intensive therapy; and fourth, maintaining the original remission (maintenance phase).
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: destroy any remaining cancer cells. destroy any residual cancer cells. kill enough cancerous cells to induce remission. follow up for recurrent disease or late effects.
kill enough cancerous cells to induce remission. Explanation: During induction, the initial phase, intensive therapy is given to kill enough cancerous cells to induce a remission. In the consolidation phase, intensive therapy is given to destroy remaining cancer cells. The maintenance phase is a designated period during which treatment is continued to destroy any residual cancer cells. During the observation phase, therapy has ended and the child is followed up for recurrent disease or late effects of treatment.
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)? joint pain and swelling anorexia and weight loss lethargy, bruises, and lymphadenopathy abdominal pain, nausea, and vomiting
lethargy, bruises, and lymphadenopathy
A 3-year old child is brought to the emergency department by the parents. Assessment reveals bruising and bleeding from the nose and mouth. The nurse suspects which condition? hemophilia von Willebrand disease (vWD) disseminated intravascular coagulation (DIC) chronic iron deficiency anemia
von Willebrand disease (vWD) Explanation: The primary clinical manifestations of vWD are bruising and mucous membrane bleeding from the nose, mouth, and gastrointestinal tract. Bleeding associated with vWD may be severe and lead to anemia and shock, but deep bleeding into joints and muscles, like that seen in hemophilia, is rare except with type III vWD.
The 2-year-old child receiving treatment for a cancer diagnosis is seen for a well-child checkup. Which health maintenance activity will the nurse exclude? administering the measles, mumps, rubella (MMR) vaccine assessing dietary intake by addressing "picky eating" and "food jags" plotting height and weight on a growth chart teaching the importance of taking water safety measures
administering the measles, mumps, rubella (MMR) vaccine Explanation: Live vaccines (viral or bacterial) should not be administered to an immunosuppressed child because of the risk of causing disease. The other health maintenance activities are important for the health maintenance of the child and should be included during the well-child visit.
A parent is angry about the adolescent's diagnosis of osteosarcoma. The parent is telling the adolescent that if he hadn't played football last year and broken his leg, this would not have happened. What is the nurse's best response to the parent's statement? "Does bone cancer run in your family? Maybe your adolescent inherited it through genes." "Cancer in the bone can result from old injuries so it probably was not caused from getting hurt last year, but an earlier injury." "Playing sports does not cause osteosarcoma. It may draw attention to the weakened bone from the tumor, though." "When your adolescent broke the leg last year, it may have weakened the bone, allowing cancer to start there."
"Playing sports does not cause osteosarcoma. It may draw attention to the weakened bone from the tumor, though."
The nurse is teaching a client about the development of leukemia. What statement should be included in the teaching plan? "Acute leukemia develops slowly." "Chronic leukemia develops slowly." "In chronic leukemia, the minority of leukocytes are mature." "In acute leukemia there are not many undifferentiated cells."
"Chronic leukemia develops slowly"
The clinic nurse is caring for a client diagnosed with leukopenia. What does the nurse know this client has? A general reduction in all white blood cells A decrease in granulocytes A general reduction in neutrophils and basophils Too many erythrocytes
A general reduction in all white blood cells
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? Applying EMLA to the injection site prior to inserting the IV. Encouraging fluid intake to increase radionuclide uptake. Advising the physician that the child is allergic to shellfish. Administering a sedative as ordered to keep the child still.
Administering a sedative as ordered to keep the child still. Explanation: The nurse would expect to administer a sedative as ordered to keep the child still because the machine makes a loud thumping noise that could frighten the child. The child must lie without moving while the MRI is being done. Encouraging fluid intake to increase radionuclide uptake is necessary for a bone scan. Advising the physician that the child is allergic to shellfish is an intervention for a computed tomograph (CT) scan with contrast. If the child did not have an IV prior to the MRI and contrast was going to be used, then an IV would need to be inserted for the contrast after the noncontrast MRI was finished. Applying EMLA to an injection site prior to inserting an IV would be appropriate for both the CT and bone scans.
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? Administer factor VIII replacement. Apply heat to the site of bleeding. Apply direct pressure to the area. Elevate the injured area such as a leg or arm.
Apply heat to the site of bleeding. Explanation: Ice or cold compresses, not heat, would be applied to the site of bleeding. Direct pressure is applied until the bleeding stops. The injured part is elevated unless elevating would contribute to further injury. Factor VIII replacement is given to replace the missing clotting factor.
A client presents with peripheral neuropathy and hypoesthesia of the feet. What is the best nursing intervention? Assess for signs of injury. Elevate the client's legs. Encourage ambulation. Keep the feet cool.
Assess for signs of injury
A client who is being treated for AML has bruises on both legs. What is the nurse's most appropriate action? Keep the client on bed rest. Evaluate the client's INR. Evaluate the client's platelet count. Ask the client whether they have recently fallen.
Evaluate the client's platelet count
Nursing students are reviewing information about childhood cancers. They demonstrate understanding of the information when they identify what as the most frequent type? Non-Hodgkin lymphoma Wilms tumor Leukemia Brain stem tumor
Leukemia Explanation: Although Wilms tumor, brain stem tumors, and non-Hodgkin lymphoma can occur in children, the most frequent type of cancer in children is leukemia.
The hospitalized client is experiencing gastrointestinal bleeding with a platelets at 9,000/mm³. The client is receiving prednisone and azathioprine. What action will the nurse take? Perform a neurologic assessment with vital signs. Use contact precautions with this client. Teach the client to vigorously floss the teeth to prevent infections. Request a prescription of diphenoxylate and atropine for loose stools.
Perform a neurological assessment with VS
The nurse is discussing disorders of the hematopoietic system when a client asked about erythrocytosis. What disease will the nurse mention with a primary characteristic of erythrocytosis? polycythemia vera sickle cell disease aplastic anemia pernicious anemia
Polycythemia vera
A nurse is caring for a client with multiple myeloma. Which nursing intervention is most appropriate for this client? Monitoring respiratory status Preventing bone injury Restricting fluid intake Balancing rest and activity
Preventing bone injury
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? respiratory distress and poor perfusion tachycardia and respiratory distress bradycardia and distinct S1 and S2 sounds wheezing and diminished breath sounds
tachycardia and respiratory distress Explanation: Increased heart rate, murmur, and respiratory distress are symptoms of hyperleukocytosis (high white blood cell count) which is associated with leukemia. Increased heart rate and blood pressure are indicative of tumor lysis syndrome, which may occur with acute lymphoblastic leukemia, lymphoma, and neuroblastoma. Wheezing and diminished breath sounds are signs of superior vena cava syndrome related to non-Hodgkin's lymphoma or neuroblastoma. Respiratory distress and poor perfusion are symptoms of massive hepatomegaly which is caused by a neuroblastoma filling a large portion of the abdominal cavity.
A 10-year-old who is receiving chemotherapy has received ondansetron before this therapy session. About an hour later, the child tells the nurse that his mouth feels really dry. The child has urinated several times and his skin turgor is normal. Which response by the nurse would be most appropriate? "The drug you got to help with the nausea can cause dry mouth." "Let me increase your intravenous fluids." "This indicates an infection. We need to start antibiotics." "You might be having a severe allergic reaction. Are you itchy?"
"The drug you got to help with the nausea can cause dry mouth." Explanation: Ondansetron is associated with dry mouth. Increasing IV fluids may or may not be appropriate. The child is urinating and his skin turgor is normal so it doesn't appear that he is dehydrated and in need of extra fluid. A severe allergic reaction would more likely be manifested by itching, hives, and increasing respiratory distress. Dry mouth is not an indicator of infection.
The parents of a child diagnosed with rhabdomyosarcoma ask the nurse to explain what this means. What is the nurse's best response? "This is a tumor of the kidney." "There is a tumor in the eye." "There is a tumor in the bone." "The tumor is in the muscle."
"The tumor is in the muscle." Explanation: A rhabdomyosarcoma is a tumor of striated muscle. A nephroblastoma (Wilms tumor) is a malignant tumor that rises from the metanephric mesoderm cells of the upper pole of the kidney. Retinoblastoma is a malignant tumor of the retina of the eye. Ewing sarcoma occurs in the bone.
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: "We should administer the drug on an empty stomach." "He might develop a rounded face from this drug." "We will need to gradually decrease the dosage." "We should check our son's urine for glucose."
"We should administer the drug on an empty stomach." Explanation: Corticosteroids are commonly administered with food to decrease the risk for gastrointestinal upset. Corticosteroids can disrupt glucose balance, so urine should be checked for glucose. A moon face is an adverse effect of corticosteroids. Corticosteroids need to be tapered gradually to reduce the risk of adrenal insufficiency.
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? 1.5 2.5 2.0 1.0
1.0 Explanation: The normal absolute neutrophil count (ANC) ranges from 1.5 to 8.0 (1500 to 8000/mm3). An ANC less than 1.5 (1500/mm3) in children over age 1 indicates neutropenia.
The nurse is caring for a child with leukemia. The parent states a variety of symptoms. Which symptoms does the nurse identify as directly related to the child's cancer? Select all that apply. Anorexia Lymphadenopathy Increased hemoglobin Increased platelet count Sore throat Bruising
Bruising Anorexia Sore throat Lymphadenopathy Explanation: Clinical and diagnostic features of leukemia include fatigue, weakness, pallor, fever, bruising, bleeding (e.g., petechiae or purpura), weight loss, anorexia, swollen gums, sore throat, recurrent infections, flu-like symptoms, abdominal pain, nausea, vomiting, bone pain, lymphadenopathy, splenomegaly, hepatosplenomegaly and elevated leukocyte count. In leukemia, hemoglobin and platelets would be decreased, not increased.
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? Drink a glass of milk Brush his or her teeth Not eat or drink for one hour Remain in an upright position for at least 15 minutes
Brush his or her teeth Explanation: To prevent staining of the teeth, the child should brush the teeth after administration of iron preparations such as ferrous sulfate. There is no need to remain upright, drink milk or to refrain from eating or drinking for one hour.
A client with polycythemia vera has a basophil count of greater than 2. Which assessment finding will the nurse expect to assess in this client? Dizziness Early satiety Pruritis Ruddy complexion
Pruritis
A client is awaiting test results to diagnose Hodgkin lymphoma. The nurse knows that which result is the hallmark for the diagnosis of this condition? Reed-Sternberg cells Elevated platelet count Increased basophils Misshaped red blood cells
Reed-Sternberg cells
A nurse is teaching the parents of a child with sickle cell disease about factors that predispose the child to a sickle cell crisis. The nurse determines that the teaching was successful when the parents identify what as a factor? Fluid overload Infection Pallor Respiratory distress
Infection Explanation: Factors that may precipitate a sickle cell crisis include: fever, infection, dehydration, hot or humid environment, cold air or water temperature, high altitude, or excessive physical activity. Respiratory distress and pallor are general signs and symptoms of a sickle cell crisis.
A nurse is teaching the parents of a child with sickle cell disease about factors that predispose the child to a sickle cell crisis. The nurse determines that the teaching was successful when the parents identify what as a factor? Pallor Respiratory distress Infection Fluid overload
Infection Explanation: Factors that may precipitate a sickle cell crisis include: fever, infection, dehydration, hot or humid environment, cold air or water temperature, high altitude, or excessive physical activity. Respiratory distress and pallor are general signs and symptoms of a sickle cell crisis.
The nurse is administering packed red blood cell (RBC) transfusions for a patient with myelodysplastic syndrome (MDS). The patient has had several transfusions and is likely to receive several more. What is a priority for the nurse to monitor related to the transfusions? Magnesium levels Creatinine and blood urea nitrogen (BUN) levels Iron levels Potassium levels
Iron levels
Which term refers to a form of white blood cell involved in immune response? Lymphocyte Granulocyte Spherocyte Thrombocyte
Lymphocyte
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? Assessing for signs of capillary leak syndrome. Assessing the child's hydration status secondary to vomiting. Monitoring for complaints of bone pain. Monitoring for allergic reactions or anaphylaxis.
Monitoring for allergic reactions or anaphylaxis. Explanation: The nurse would monitor for infusion-related reactions and anaphylaxis if monoclonal antibodies were administered and would have epinephrine, antihistamines, and steroids available at the bedside for treatment if a reaction occurred. Assessing the level of hydration due to vomiting would be necessary if tumor necrosis factor was administered. The flu-like symptoms produced by interferons also require hydration maintenance. Monitoring for complaints of bone pain is appropriate when administering colony-stimulating factors such as filgrastim or sargramostim. Assessing for signs of capillary leak syndrome within 2 to 12 hours of the start of treatment is necessary when interleukins are used.
The nurse is caring for a patient who will begin taking long-term biphosphate therapy. Why is it important for the nurse to encourage the patient to receive a thorough evaluation of dentition, including panoramic dental x-rays? The patient can develop loosening of the teeth. The patient is at risk for tooth decay. The patient will develop gingival hyperplasia. The patient can develop osteonecrosis of the jaw.
The patient can develop osteonecrosis of the jaw.
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 synthesized naturally by various bacterial and fungal agents. They damage cells by acting as a substitute for a natural metabolite in an important molecule. They are cell cycle-nonspecific, destroying both resting and dividing cells. They are most active in the S phase and act similarly to normal cellular metabolites necessary for cell replication.
They are cell cycle-nonspecific, destroying both resting and dividing cells. Explanation: Alkylating agents are cell cycle-nonspecific, destroying both resting and dividing cells. During alkylation, the hydrogen atoms of some molecules within the cell are replaced by an alkyl group. This group interferes with DNA replication and RNA transcription.
The parents of a 6-year-old child with idiopathic thrombocytopenic purpura (ITP) ask the nurse, "What causes this disease?" Which response by the nurse would be most appropriate? "ITP is primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason." "ITP occurs when the body's iron stores are depleted due to rapid physical growth, inadequate iron intake, inadequate iron absorption, or loss of blood." "ITP is characterized by the loss of surface area on the red blood cell membrane." "ITP is a serious bleeding disorder characterized by a decreased, absent, or dysfunctional coagulation."
"ITP is primarily an autoimmune disease in that the immune system attacks and destroys the body's own platelets, for an unknown reason."
The nurse is preparing a discharge teaching plan for the parents of an 8-year-old girl with leukemia. Which instruction would be the priority? Keeping a written copy of the treatment plan Using acetaminophen if the child needs an analgesic Writing down phone numbers and appointments Calling the doctor if the child gets a sore throat
Calling the doctor if the child gets a sore throat Explanation: Calling the doctor if the child gets a sore throat is the priority. Because of the child's impaired immune system, any sign of potential infection, such as sore throat, must be evaluated by a physician. Using acetaminophen if the child needs an analgesic, writing down phone numbers and appointments, and keeping a written copy of the treatment plan are important teaching points—but secondary to guarding against infection.
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? Provide diversional activities for the child. Implement strategies to address the child's pain. Ask the parent if he or she has questions about the plan of care. Contact the health care provider to meet with the parent.
Implement strategies to address the child's pain
A patient with AML is having aggressive chemotherapy to attempt to achieve remission. The patient is aware that hospitalization will be necessary for several weeks. What type of therapy will the nurse explain that the patient will receive? Antimicrobial therapy Induction therapy Supportive therapy Standard therapy
Induction therapy
A client has completed induction therapy and has diarrhea and severe mucositis. What is the appropriate nursing goal? Administer pain medication. Place the client in reverse isolation. Address issues of negative body image. Maintain nutrition.
Maintain nutrition
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? Lymphadenopathy Mediastinal mass Tumor in the liver Retinoblastoma
Mediastinal mass Explanation: Difficulty breathing or respiratory distress may indicate a mediastinal mass (which may be seen on a radiograph) in the client with Hodgkin disease. Hepatomegaly or splenomegaly may occur when there is advanced disease. Lymphadenopathy is present in the cervical and supraclavicular nodes. These could be palpated and do not require an x-ray to diagnose. Presence of a white reflection in the pupil of the eye may indicate retinoblastoma.
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? Allowing the child to listen during discussions of the care plan. Explaining the prognosis using accepted clinical terminology. Telling the child exactly what to expect of further treatments. Encouraging the child to support the wishes of her parents.
Telling the child exactly what to expect of further treatments. Explanation: The committee recommends telling the child exactly what to expect of further treatments and procedures, explaining the prognosis in a developmentally appropriate way to ensure the child's understanding, and endeavoring to gain the child's candid opinion of the proposed care plan. It also recommends that decision-making for older children and adolescents should include the assent of the child or adolescent.
Which patient assessed by the nurse is most likely to develop myelodysplastic syndrome (MDS)? A 52-year-old patient with acute kidney injury A 40-year-old patient with a history of hypertension A 24-year-old female taking oral contraceptives A 72-year-old patient with a history of cancer
A 72-year-old patient with a history of cancer
An elderly client is hospitalized for induction of chemotherapy to treat leukemia. The client reports fatigue to the nurse. What nursing intervention would best address the client's fatigue? Talk to the family about not visiting so the client can obtain rest. Have the client maintain complete bedrest. Provide sedentary activities only, such as watching television. Assist the client to sit in a chair for meals.
Assist the client to sit in a chair for meals
Which nursing diagnosis should the nurse identify as being the most appropriate for a child with idiopathic thrombocytopenic purpura? Risk for bleeding related to insufficient platelet formation Risk for infection related to abnormal immune system Ineffective breathing pattern related to decreased white blood count Risk for altered urinary elimination related to kidney impairment
Risk for bleeding related to insufficient platelet formation Explanation: Idiopathic thrombocytopenic purpura is the result of a decrease in the number of circulating platelets in the presence of adequate megakaryocytes, which are precursors to platelets. Because bleeding can occur with this disease process, the diagnosis most appropriate for the client at this time is risk for bleeding related to insufficient platelet formation. Reduced numbers of platelets would not increase the client's risk for infection. Reduced numbers of platelets does not increase the client's risk for renal impairment. Reduced risk of platelets will not lead to an ineffective breathing pattern.
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 decreased D-dimer assay increased antithrombin III levels platelet count 10,000/mm3 (10 ×109/L)
uncontrolled bleeding Explanation: DIC is a complex condition that is secondary to other problems such as sepsis. It is life-threatening. Symptoms of DIC include uncontrolled bleeding, petechiae, ecchymosis, purpuric rash, prolonged prothrombin time and partial thromboplastin time, an increased D-dimer assay, decreased antithrombin III levels, below-normal fibrinogen levels, and increased fibrin-degradation products. The platelet count is decreased in DIC. In moderate to severe cases it is less than 50,000/mm3 (50 ×109/L). The symptom the nurse would see first is uncontrolled bleeding. The remainder are laboratory results that would be used to make the diagnosis.
While assessing an adolescent, the nurse notes pallor and a beefy red tongue. Upon questioning, the adolescent reports eating a vegetarian diet to help with weight loss. Which health care provider prescription will the nurse anticipate? folic acid supplement hydroxyurea orally vitamin B12 injections ferrous sulfate daily
vitamin B12 injections Explanation: Children with pernicious anemia have a vitamin B12 deficiency and have symptoms such as pallor, irritability, beefy red tongue, and diarrhea. Children with iron-deficiency anemia require ferrous sulfate. Folic acid is needed for children with macrocytic anemia. Hydroxyurea could be prescribed for a child with sickle cell anemia.
The nurse is teaching a client about the development of leukemia. What statement should be included in the teaching plan? "Acute leukemia develops slowly." "In chronic leukemia, the minority of leukocytes are mature." "Chronic leukemia develops slowly." "In acute leukemia there are not many undifferentiated cells."
"Chronic leukemia develops slowly"
The nurse is caring for a toddler taking ferrous sulfate for severe iron-deficiency anemia. Which report by the parent is most concerning? "I mix ferrous sulfate with milk in a bottle." "My child takes ferrous sulfate after meals." "I brush my child's teeth once every day." "My child's stools are darker than usual."
"I mix ferrous sulfate with milk in a bottle." Explanation: Ferrous sulfate may not be absorbed if taken with milk or tea, and if the parent mixes the medicine with milk in a bottle, there is also concern that if the child does not drink the entire amount of medication. Ferrous sulfate may be taken after meals to prevent gastrointestinal irritation. Dark stools are a common side effect of ferrous sulfate. Parents should be encouraged to brush the child's teeth thoroughly to prevent teeth staining.
A client presents with peripheral neuropathy and hypoesthesia of the feet. What is the best nursing intervention? Keep the feet cool. Assess for signs of injury. Encourage ambulation. Elevate the client's legs.
Assess for signs of injury
The nurse is admitting to an examination room a child with the diagnosis of "probable acute lymphoblastic leukemia (ALL)." What will confirm this diagnosis? Lethargy, bruising, and pallor Bone marrow aspiration History of leukemia in twin Complete white blood count
Bone marrow aspiration
The nurse suspects that a client has multiple myeloma based on the client's major presenting symptom and the analysis of laboratory results. What classic symptom for multiple myeloma does the nurse assess for? Bone pain in the back of the ribs Severe thrombocytopenia Debilitating fatigue Gradual muscle paralysis
Bone pain in the back of the ribs
The nurse is caring for a 10-year-old girl with iron toxicity. What would the nurse expect the physician to order? Succimer Dimercaprol Deferasirox Edetate calcium disodium
Deferasirox Explanation: Deferasirox is indicated for iron toxicity. It binds with iron, which is removed via the kidneys. Dimercaprol is indicated for blood lead levels greater than 45 mcg/dl. It removes lead from soft tissues and bone, allowing for its excretion via the renal system. Edetate calcium disodium is indicated for blood lead levels greater than 45 mcg/dl. The medication removes lead from soft tissues and bone, allowing for its excretion via the renal system. Succimer is indicated for blood lead levels greater than 45 mcg/dl; it removes lead from soft tissues and bone, allowing for its excretion via the renal system.
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? Hodgkin disease Ewing sarcoma non-Hodgkin lymphoma neuroblastoma
Ewing sarcoma
The nurse has been asked to participate in a community health teaching session. Which interventions would the nurse include to help achieve the 2030 National Health Goals to reduce the incidence of anemias? Select all that apply. Emphasize ways to reduce unintentional injuries at home, work, and play. Explain the importance of healthy eating for adolescent participants. Examine strategies for elderly community members to improve the quality of life. Instruct pregnant women to take iron supplementation as prescribed. Review foods that are rich in iron that should be a part of a school-age child's diet.
Explain the importance of healthy eating for adolescent participants. Instruct pregnant women to take iron supplementation as prescribed. Review foods that are rich in iron that should be a part of a school-age child's diet.
A client with primary myelofibrosis is diagnosed with splenomegaly. Which medications will the nurse prepare teaching for this client? Select all that apply. Thalidomide Pomalidomide Hydroxyurea Anagrelide Interferon-alfa
Hydroxyurea Thalidomide Pomalidomide
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? The infant tugs and pulls at one ear. One pupil appears white. The infant's eye appears to be protruding. The infant always keeps her eyes tightly closed.
One pupil appears white. Explanation: On examination, the child's pupil of the affected eye appears white because the red reflex is absent. Some might describe this symptom as a "cat's eye." Ear tugging, eye protrusion, and keeping the eyes closed are not manifestations of retinoblastoma.
The nurse is caring for a client with multiple myeloma. Why would it be important to assess this client for fractures? Osteoclasts break down bone cells so pathologic fractures occur. Osteolytic activating factor weakens bones producing fractures. Osteosarcomas form producing pathologic fractures. Osteopathic tumors destroy bone causing fractures.
Osteoclasts break down bone cells so pathologic fractures occur
The nurse is caring for a client with multiple myeloma. Why would it be important to assess this client for fractures? Osteoclasts break down bone cells so pathologic fractures occur. Osteosarcomas form producing pathologic fractures. Osteolytic activating factor weakens bones producing fractures. Osteopathic tumors destroy bone causing fractures.
Osteoclasts break down bone cells so pathologic fractures occur
Which nursing diagnosis should the nurse identify as being the most appropriate for a child with idiopathic thrombocytopenic purpura? Risk for altered urinary elimination related to kidney impairment Risk for infection related to abnormal immune system Risk for bleeding related to insufficient platelet formation Ineffective breathing pattern related to decreased white blood count
Risk for bleeding related to insufficient platelet formation
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? von Willebrand disease disseminated intravascular coagulation iron-deficiency anemia hemophilia
disseminated intravascular coagulation Explanation: Disseminated intravascular coagulation (DIC) is an acquired coagulopathy that, paradoxically, is characterized by both thrombosis and hemorrhage. The outcome for this client is: The child will maintain adequate tissue perfusion of all body systems affected by DIC and regain adequate laboratory values for hemostasis. von Willebrand disease and hemophilia involve hemorrhage but not thrombosis. Iron deficiency anemia does not involve either hemorrhage or thrombosis.
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 difficulty or pain when swallowing earache, stiff neck, or sore throat blisters, ulcers, or a rash appear
temperature of 101°F (38.3°C) or greater Explanation: The parents should seek medical care immediately if the child has a temperature of 101°F (38.3° C) or greater. This is because many chemotherapeutic drugs cause bone marrow suppression; the parents must be directed to take action at the first sign of infection in order to prevent overwhelming sepsis. The appearance of earache, stiff neck, sore throat, blisters, ulcers, or rashes (or difficulty/pain when swallowing) are reasons to seek medical care, but are not as grave as the risk of infection.
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. Promoting exercise and activity Administering analgesics Administering oxygen Administering platelets Maintaining fluid intake
Administering oxygen Maintaining fluid intake Administering platelets Explanation: A vaso-occlusive crisis occurs when sickle-shaped cells are clumped together in a joint or organ. This causes severe pain and hypoxia to the tissues. The management for a vaso-occlusive crisis is to provide adequate pain relief, oxygen to correct the hypoxemia, and increased IV fluids to thin out viscosity and allow the cells to flow in the vascular system. Platelet administration is not indicated as part of the treatment. Children and adults experiencing a sickle cell crisis experience a high degree of pain, so exercise and activity is postponed until the crisis is over. Activity is encouraged when the child is not in crisis as it promotes growth and a positive self-image.
When providing care for a child immediately after a bone marrow aspiration, which nursing action is priority? Educate the family on proper handwashing. Monitor the site dressing and vital signs. Allow the child to play with a doll and syringe. Evaluate pain and administer medication.
Monitor the site dressing and vital signs. Explanation: Monitoring vital signs and the dressing for signs of bleeding is a priority after bone marrow aspiration. Although providing pain medication, educating on handwashing, and allowing for therapeutic play are all important, these should only be performed after first stabilizing the child.
The nurse cares for an older adult client with unprovoked back pain and increased serum protein. Which hematologic neoplasm does the nurse suspect the client has? Chronic myeloid leukemia Hodgkin lymphoma Non-Hodgkin lymphoma Multiple myeloma
Multiple myeloma
A child is undergoing a series of diagnostic tests for a suspected malignancy. Which diagnostic test result is only present in Hodgkin disease? elevated lymphocytes Reed-Sternberg cells T-lymphocyte surface markers megakaryocyte cells
Reed-Sternberg cells Explanation: With Hodgkin disease, lymphocytes proliferate in the lymph glands, and special Reed-Sternberg cells (large, multinucleated cells that are probably nonfunctioning monocyte-macrophage cells) develop. Although these lymphocytes are capable of DNA synthesis and mitotic division, they are abnormal because they lack both B- and T-lymphocyte surface markers and cannot produce immunoglobulins as do usual B-lymphocytes. There will be elevated lymphocytes, but this is present in leukemias as well. T-lymphocyte surface markers are lacking in Hodgkin disease. Megakaryocyte cells are normal cells in the bone marrow and produce platelets.
A group of nursing students are studying information about childhood cancers in preparation for a class examination. They are reviewing how childhood cancers differ from adult cancers. The group demonstrates understanding of the information when they identify what location as an unlikely site for childhood cancer? Bladder Brain Blood Kidney
Bladder Explanation: The most common sites for childhood cancer include the blood, lymph, brain, bone, kidney, and muscle. Bladder is a common site for adult cancer.
A group of nursing students are studying information about childhood cancers in preparation for a class examination. They are reviewing how childhood cancers differ from adult cancers. The group demonstrates understanding of the information when they identify what location as an unlikely site for childhood cancer? Brain Bladder Blood Kidney
Bladder Explanation: The most common sites for childhood cancer include the blood, lymph, brain, bone, kidney, and muscle. Bladder is a common site for adult cancer.
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. Obtain a blood culture. Apply oxygen as needed. Give an antihistamine. Administer a diuretic. Discontinue the transfusion.
Give an antihistamine. Apply oxygen as needed Discontinue the transfusion.
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. Eliminate second-hand smoke within the home. Siblings and parents should not receive nonlive vaccines. Growth may be stunted due to chemotherapy.
No routine live vaccines are administered while on chemotherapy. Explanation: Children with cancer need much of the same well-child maintenance care that all children do, with one exception. While they are undergoing chemotherapy, which causes a decreased immune response, they should not receive "routine" vaccines, especially live vaccines. The siblings in the home can receive all nonlive vaccines, and the entire family (including the child undergoing treatment) is encouraged to receive a yearly flu vaccine. Growth and development are monitored during well-child visits, but it is not necessarily true that growth and development may be stunted. It is always a good idea to eliminate second-hand smoke for all children, not just for children with cancer. Childhood cancers do not seem to be related to environmental contaminants.
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: Hodgkin disease. neuroblastoma. leukemia. osteosarcoma.
neuroblastoma. Explanation: A 24-hour urine specimen for catecholamines (homovanillic acid [HVA] and vanillylmandelic acid [VMA]) is used to help diagnose neuroblastoma because this cancer produces catecholamines; thus, levels will be elevated. This test is not used to diagnose Hodgkin disease, leukemia, or osteosarcoma.
The nurse is caring for a client with multiple myeloma. Why would it be important to assess this client for fractures? Osteopathic tumors destroy bone causing fractures. Osteoclasts break down bone cells so pathologic fractures occur. Osteosarcomas form producing pathologic fractures. Osteolytic activating factor weakens bones producing fractures.
osteoclasts break down bone cells so pathologic fractures occur
Which child is at highest risk for Ewing sarcoma? 15-year-old male who reports dull bone pain just below the knee 4-year-old female whose parents note a mass on the child's abdomen 13-year-old female who reports intermittent pain located in the pelvis 3-year-old male whose parents note a mass on the child's neck
13-year-old female who reports intermittent pain located in the pelvis Explanation: Ewing sarcoma occurs most frequently in the pelvis or femur and is accompanied by a history for intermittent pain that progressively worsens, such as reported by the 13-year-old female client. Osteosarcoma occurs most frequently in adolescents and males and presents with dull bone pain that may be present for several months, eventually progressing to limp or gait changes, such as reported by the 15-year-old male client. Rhabdomyosarcoma is a soft tissue tumor most commonly located in the head and neck, genitourinary tract, and extremities. Diagnosis is usually made between 2 and 5 years of age, with the majority of all rhabdomyosarcomas diagnosed by age 10 years. The child or parent will often discover an asymptomatic mass and seek medical attention at that time. Wilms tumor most commonly occurs between the ages of 2 and 5 years. Parents typically initially observe the abdominal mass associated with Wilms tumor.
A nurse is giving instructions to the father of a boy who is receiving chemotherapy (including methotrexate) regarding how best to care for the boy during this period of treatment. What should the nurse mention to him? Give him aspirin to help manage pain Keep him away from people with known infections Be sure that the boy receives only live-virus vaccines Give the boy folic acid supplements
Keep him away from people with known infections Explanation: A child receiving chemotherapy is particularly susceptible to contracting an infection so should be kept away from people with known infections. Caution parents not to give aspirin for pain to children receiving chemotherapy; in addition to increasing the child's susceptibility to Reye syndrome, aspirin may interfere with blood coagulation, a problem that may already be present because of lowered thrombocyte levels. A parent who wants to give a child vitamins should check with the primary health care provider to be certain the vitamin preparation will not interfere with a chemotherapeutic agent. Administration of a vitamin that contains folic acid, for example, could interfere with the effectiveness of methotrexate, a folic acid antagonist. Caution parents that live-virus vaccines should not be given during chemotherapy as these vaccines could cause widespread viral disease if the child's immune mechanism is deficient.
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 tumor has not extended into the surrounding tissue and can be completely removed surgically. The cancer has spread in the brain itself but the chance of complete surgical removal is good. Cancer cells have spread to local lymph nodes. Tumors have spread systemically throughout the body.
The cancer has spread in the brain itself but the chance of complete surgical removal is good. Explanation: Knowing the stage of a tumor helps the health care team design an effective treatment program, establish an accurate prognosis, and evaluate the progress or regression of the disease. In general, stage I refers to a tumor that has not extended into the surrounding tissue so can be completely removed surgically; stage II means there is some local spread but the chance for complete surgical removal is good. Stage III typically means cancer cells have spread to local lymph nodes; stage IV designates tumors that have spread systemically (metastasis).
Which symptom would lead the nurse to suspect that a child is developing a common side effect of vincristine? The child's hearing seems to be altered. The child says the teeth "ache." The child says the fingertips feel numb. The cheeks are turning bright red.
The child says the fingertips feel numb. Explanation: Vincristine has a number of side effects. Myelosuppression occurs,, which can cause decreased blood counts, hemorrhage, and anemia. A common side effect of vincristine is numbness and tingling in the hands and feet. Allopurinol is administered when the child is receiving vincristine, because the dying cancer cells cause increased uric acid. A side effect of the allopurinol is blistering, peeling, and red skin rash. With both of the drugs the child should be properly hydrated to prevent side effects. Toothache and hearing loss are symptoms of side effects of other chemotherapeutic agents, but not vincristine.
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? providing a high dose of intravenous immunoglobulin weekly packed red blood cell transfusions increasing the daily intake of fresh fruits and vegetables giving ferrous sulfate with orange juice between meals
giving ferrous sulfate with orange juice between meals Explanation: Treatment for iron-deficiency anemia is the administration of ferrous sulfate for a 13-year-old client with a hemoglobin at 11 g/dL (110 g/L). It should be administered with orange juice, because vitamin C helps absorb iron. It should not be taken with milk. It can cause teeth staining in children and should be given with a straw. Intravenous immunoglobulin would be administered for idiopathic thrombocytopenic purpura. The client's hemoglobin level is not severe enough to warrant blood transfusions at this time. There is also no indication the child is symptomatic. Anemia is generally diagnosed for a hemoglobin less than 12 g/dL (120 g/L) in children 12 to 14 years of age. The normal level for children 12 to 18 years of age is 14 g/dL (140 g/L). While increasing fresh fruits and vegetables is good for the client's overall health, this client needs foods specifically high in iron. These include broccoli, bananas, tomatoes, spinach, liver, nuts, dates, legumes, beef, eggs, and pork.
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? painless, enlarged lymph node night sweats anorexia weight loss
painless, enlarged lymph node Explanation: Children with Hodgkin lymphoma typically present with swollen, painless, and rubbery-feeling lymph nodes in the cervical or supraclavicular region. Depending on the extent of the disease at diagnosis, other symptoms may be present. However, this child was diagnosed in stage I (asymptomatic). If the lymph nodes of the chest are involved, the child has moved to the symptomatic stages and may experience dyspnea and cough. Chest pain may result from the pressure exerted by the enlarged nodes. General symptoms can also include fever, drenching night sweats, and weight loss.
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? Refer the adolescent to a peer support group. Support the adolescent's choice of comfortable clothing. Encourage the adolescent to select hats or wigs to fit one's personality. Have a Child Life specialist work with the adolescent.
Encourage the adolescent to select hats or wigs to fit one's personality. Explanation: A positive body image is important, especially to an adolescent. It is important for the nurse to acknowledge the adolescent's feelings of sadness over the body changes caused by the illness. To help the adolescent have some power over the illness, the nurse should encourage the adolescent to choose wigs, hats, or scarves that fit his or her personality or even meet a goal of doing something the adolescent would not have dared to before. This could be a wig of different hair color or a big floppy hat with sequins. Whatever the choice, this gives the adolescent a feeling of being in control of the situation and able to make the decisions. Nurses should support the adolescent's choice of clothing. Most likely the adolescent will choose clothing for comfort. Loose clothing disguises weight loss or scarring while promoting self-esteem. Referring the adolescent to a support group or the help of a Child Life specialist are good interventions. Both will help the adolescent work through the feelings of loss, but neither gives the adolescent the ability to make decisions about outward appearance.
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? Growth may be stunted due to chemotherapy. Eliminate second-hand smoke within the home. Siblings and parents should not receive nonlive vaccines. No routine live vaccines are administered while on chemotherapy.
No routine live vaccines are administered while on chemotherapy. Explanation: Children with cancer need much of the same well-child maintenance care that all children do, with one exception. While they are undergoing chemotherapy, which causes a decreased immune response, they should not receive "routine" vaccines, especially live vaccines. The siblings in the home can receive all nonlive vaccines, and the entire family (including the child undergoing treatment) is encouraged to receive a yearly flu vaccine. Growth and development are monitored during well-child visits, but it is not necessarily true that growth and development may be stunted. It is always a good idea to eliminate second-hand smoke for all children, not just for children with cancer. Childhood cancers do not seem to be related to environmental contaminants.
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? increased antithrombin III levels platelet count 10,000/mm3 (10 ×109/L) decreased D-dimer assay uncontrolled bleeding
uncrontrolled bleeding
The nurse is assessing a client with chronic lymphocytic leukemia. Which assessment findings indicate to the nurse that the client is experiencing B symptoms of the condition? Select all that apply. Epistaxis Unintentional weight loss of 10% Ecchymosis Drenching night sweats Intermittent fever
unintentional weight loss of 10% drenching night sweats intermittent fever
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 acute blood loss sickle-cell disorder iron deficiency
vitamin B12 deficiency Explanation: Vitamin B12 is necessary for the maturation of RBCs. Pernicious anemia results from deficiency or inability to use the vitamin, resulting in RBCs that appear abnormally large and are immature megaloblasts (nucleated immature red cells). Thus, pernicious anemia is one of the megaloblastic anemias. In children, the cause is more often lack of ingestion of vitamin B12 rather than poor absorption. Adolescents may be deficient in vitamin B12 if they have a long-term, poorly formulated vegetarian diet, as the vitamin is found primarily in foods of animal origin. Since the client is taking iron, iron deficiency anemia is ruled out. The blood cells in a client with sickle cell anemia are crescent-shaped and do not display the characteristics noted. There are no symptoms of blood loss or acute bleeding, as the client is otherwise healthy.