Deck 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder

Question 1

The nurse is conducting a physical examination of a toddler with suspected lead poisoning. Lab results indicate blood lead level 52 m g/dL. Which action would the nurse expect to happen next?

A) Repeat testing within 2 days and prepare to begin chelation therapy as ordered
B) Repeat testing within 1 week with education to decrease lead exposure
C) Confirm with repeat testing in 1 month and referral to local health department
D) Prepare to admit child to begin chelation therapy

Answer 1

Repeat testing within 2 days and prepare to begin chelation therapy as ordered

Question 2

A nurse is conducting a physical examination of a 5-year-old with suspected iron- deficiency anemia. How would the nurse evaluate for changes in neurologic functioning?

A) "Open your mouth so I can look inside your cheeks and lips."
B) "Do you have any bruises on your feet or shins?"
C) "Will you show me how you walk across the room?"
D) "Let me see the palms of your hands and soles of your feet."

Answer 2

"Will you show me how you walk across the room?"

Question 3

The nurse is caring for a 12-year-old boy with idiopathic thrombocytopenia. The nurse is providing discharge instructions about home care and safety recommendations to the boy and his parents. Which response indicates a need for further teaching?

A) "We should avoid aspirin and drugs like ibuprofen."
B) "He can resume participation in football in 2 weeks."
C) "Swimming would be a great activity."
D) "Our son cannot take any antihistamines."

Answer 3

"He can resume participation in football in 2 weeks."

Question 4

The nurse is assessing a child with suspected thalassemia. Which of the following would the nurse expect to assess?

A) Dactylitis
B) Frontal bossing
C) Presence of clubbing
D) Presence of spooning

Question 5

The nurse is caring for a child recently diagnosed with glucose-6-phosphate dehydrogenase (G6PD) deficiency. The nurse is teaching the parents about triggers that may result in oxidative stress. Which of the following responses indicates a need for further teaching?

A) "I doubt he will ever eat fava beans, but they could trigger hemolysis."
B) "He must avoid exposure to naphthalene, an agent found in mothballs."
C) "He must never take methylene blue for a urinary tract infection."
D) "My son can never take penicillin for an infection."

Question 6

The nurse is caring for a 13-year-old girl with von Willebrand disease. After teaching the adolescent and her parents about this disorder and care, which response by the parents indicates a need for additional teaching?

A) "We need to administer Stimate prior to dental work."
B) "We should be aware that she may suffer from menorrhagia."
C) "We should administer desmopressin as often as needed."
D) "We understand that she may have frequent nosebleeds."

Question 7

The nurse is caring for a child who has been admitted for a sickle cell crisis. Which of the following would the nurse do first to provide adequate pain management?

A) Administer a nonsteroidal anti-inflammatory drug as ordered.
B) Use guided imagery and therapeutic touch.
C) Administer meperidine as ordered.
D) Initiate pain assessment with a standardized pain scale.

Question 8

The nurse is caring for a 2-year-old boy with hemophilia. His parents are upset by the possibility that he will become infected with hepatitis or HIV from the clotting factor replacement therapy. Which response by the nurse would be most appropriate?

A) "Parents commonly fear the worst; however, the factor will help your child lead anormal life."
B) "There are risks with any treatment including using blood products, but these arevery minor."
C) "Although factor replacement is expensive, there's more financial strain frommissing work if he has a bleeding episode."
D) "Since dry heat treatment of the factor began in 1986, there have been no reportsof virus transmission."

Question 9

A child with iron-deficiency anemia is prescribed ferrous fumarate, 3 mg/kg/day in two divided doses. The nurse interprets this order as indicating which of the following?

A) The child requires a prophylactic dose of iron.
B) The child has mild to moderate iron deficiency.
C) The child has severe iron deficiency.
D) The child is being prepared for packed red blood cell administration.

Question 10

The nurse is caring for a child with thalassemia who is receiving chelation therapy at home using a battery-operated pump. After teaching the parents about this treatment, which statement by the mother indicates a need for additional teaching?

A) "I can have the nurse administer the chelation therapy if I am uncomfortable."
B) "I must be very careful to strictly adhere to the chelation regimen."
C) "The deferoxamine binds to the iron so it can be removed from the body."
D) "The medication can be administered while my child is sleeping."

Question 11

The nurse is teaching the parents of a child with a hematologic disorder about the functions of the various blood cells. The nurse determines that the teaching was successful when the parents state which blood cell as being primarily responsible for blood clotting?

A) Granulocytes
B) Erythrocytes
C) Thrombocytes
D) Leukocytes

Question 12

When evaluating the hemogram of an 8-month-old infant, the nurse would identify which type of hemoglobin as being the predominant type?

A) Hemoglobin A
B) Hemoglobin F
C) Hemoglobin A₂
D) Hemoglobin S

Question 13

The nurse is evaluating the laboratory test results of a 7-year-old child with a suspected hematologic disorder. Which finding would cause the nurse to be concerned?

A) WBC: 5.6 × 10³/mm³
B) RBC: 2.8 × 10⁶/mm³
C) Hemoglobin: 11.4 mg/dL
D) Hematocrit: 35%

Question 14

When providing care to a child with aplastic anemia, which nursing diagnosis most likely would be the priority?

A) Risk for injury
B) Imbalanced nutrition, less than body requirements
C) Ineffective tissue perfusion
D) Impaired gas exchange

Question 15

The nurse is reviewing the laboratory test results of a child diagnosed with disseminated intravascular coagulation (DIC). Which of the following would the nurse interpret as indicative of this disorder?

A) Shortened prothrombin time
B) Increased fibrinogen level
C) Positive fibrin split products
D) Increased platelets

Question 16

A nurse is providing care to a child with idiopathic thrombocytopenic purpura with a platelet count of 18,000/mm³. Which medication would the nurse most likely expect to be ordered?

A) Folic acid
B) Intravenous immune globulin
C) Dimercaprol
D) Deferoxamine

Question 17

The nurse is reviewing the white blood cell differential of a 4-year-old girl. Which value would lead the nurse to be concerned?

A) Bands: 8%
B) Segs: 28%
C) Eosinophils: 10%
D) Basophils: 0%

Question 18

A child with suspected sickle cell disease is scheduled for a hemoglobin electrophoresis. When reviewing the child's history, which of the following would the nurse identify as potentially interfering with the accuracy of the results?

A) Use of iron supplementation
B) Blood transfusion 1 month ago
C) Lack of fasting for 12 hours
D) History of recent infection

Question 19

The mother of a 5-year-old girl brings the child to the clinic for an evaluation. The mother tells the nurse, "She seems to be so tired and irritable lately. And she looks so pale." Further assessment reveals pale conjunctiva and oral mucous membranes. The nurse suspects iron- deficiency anemia. Which additional finding would help provide additional evidence for this suspicion?

A) Spooned nails
B) Negative splenomegaly
C) Oxygen saturation: 99%
D) Bradycardia

Question 20

The nurse is teaching the parents of a child diagnosed with iron-deficiency anemia about ways to increase their child's intake of iron. The parents demonstrate understanding of the teaching when they identify which foods as good choices for the child? Select all that apply.

A) Tuna
B) Salmon
C) Tofu
D) Cow's milk
E) Dried fruits

Question 21

A child is prescribed monthly injections of vitamin B₁₂. When developing the teaching plan for the family, the nurse would focus on which type of anemia?

A) Aplastic anemia
B) Pernicious anemia
C) Folic acid anemia
D) Sickle cell anemia

Question 22

A nurse is leading a discussion with a group of new mothers about newborn nutrition and its importance for growth and development. One of the mothers asks, "Doesn't the baby get iron from me before birth?" Which response by the nurse would be most appropriate?

A) "You give the baby some iron, but it is not enough to sustain him after birth."
B) "Because the baby grows rapidly during the first months, he uses up what you gave him."
C) "The iron you give him before birth is different from what he needs once he is born."
D) "If the baby didn't use up what you gave him before birth, he excretes it soon after birth."

Question 23

A 5-year-old girl is diagnosed with iron-deficiency anemia and is to receive iron supplements. The child has difficulty swallowing tablets, so a liquid formulation is prescribed. After teaching the parents about administering the iron supplement, which statement indicates the need for additional teaching?

A) "She needs to eat foods that are high in fiber so she doesn't get constipated."
B) "We'll try to get her to drink lots of fluids throughout the day."
C) "We will place the liquid in the front of her gums, just below her teeth."
D) "We need to measure the liquid carefully so that we give her the correct amount."

Question 24

The nurse is assessing a child with aplastic anemia. Which of the following would the nurse expect to assess? Select all that apply.

A) Ecchymoses
B) Tachycardia
C) Guaiac-positive stool
D) Epistaxis
E) Severe pain
F) Warm tender joints

Question 25

An adolescent weighing 55 kg is admitted to the hospital experiencing a sickle cell crisis. Intravenous fluid therapy as well as increased oral fluids are ordered as part of his treatment plan. Based on the understanding of the amount of fluids needed to promote hemodilution, the nurse would expect the adolescent to receive how much total fluid in 24 hours?

Question 26

The nurse is developing a plan of care for a child with thalassemia. Which of the following would the nurse expect to include? Select all that apply.

A) Packed RBC transfusions
B) Deferoxamine therapy
C) Heparin therapy
D) Opioid analgesics
E) Platelet transfusions
F) Intravenous immunoglobulin

Question 27

A group of students are reviewing information about glucose-6-phosphate dehydrogenase (G6PD) deficiency. The students demonstrate understanding of the material when they identify this disorder as due to which of the following?

A) X-linked recessive inheritance
B) Deficiency in clotting factors
C) An excess supply of iron
D) Autosomal recessive inheritance

Question 28

The nurse is caring for a 16-year-old boy with acute myelogenous leukemia who is having chemotherapy and who has incomplete records for varicella zoster immunization. Which of the following will be the priority nursing diagnosis?

A) Pain related to adverse effects of treatment verbalized by the child
B) Nausea related to side effects of chemotherapy verbalized by the child
C) Constipation related to the use of opioid analgesics for pain
D) Risk for infection related to neutropenia and immunosuppression

Question 29

The nurse is caring for an 8-year-old girl who has been diagnosed with leukemia and will have a variety of tests, including a lumbar puncture, before beginning chemotherapy. Which of the following would be the priority?

A) Applying EMLA to the lumbar puncture site
B) Educating the child and family about the testing procedures
C) Administering promethazine as ordered for nausea
D) Educating the family about chemotherapy and its side effects

Question 30

The nurse is caring for a 13-year-old boy with acute myelogenous leukemia who is experiencing feelings of powerlessness due to the effects of chemotherapy. Which of the following interventions will best help the teen's sense of control?

A) Involving the boy in decisions whenever possible
B) Acknowledging the boy's feelings of anger with the disease
C) Providing realistic expectations of treatments and outcomes
D) Recognizing abilities that are unaffected by the disease

Question 31

The nurse is caring for a 5-year-old girl with a disseminated medulloblastoma. Which of the following interventions would be most appropriate for this situation?

A) Providing emotional support to the parents and siblings of the child
B) Recommending support groups for people whose children have cancer
C) Encouraging the family to cry and express feelings away from the child
D) Educating the family about the disease, its treatments, and side effects

Question 32

The nurse is assessing a 3-year-old boy whose parents brought him to the clinic when they noticed that the right side of his abdomen was swollen. Which of the following findings would suggest this child has a neuroblastoma?

A) The child has a maculopapular rash on his palms.
B) The parents report that their son is vomiting and not eating well.
C) The parents report that their son is irritable and not gaining weight.
D) Auscultation reveals wheezing with diminished lung sounds.

Question 33

The nurse is educating the parents of a 4-year-old boy with a Wilms tumor who is about to have chemotherapy prior to surgery. Which statement by the parents indicates that the nurse should review the instructions about preventing infection?

A) "He takes his antibiotic twice a day."
B) "We check his temperature orally."
C) "We keep him away from crowds."
D) "He must be clean and his teeth brushed."

Question 34

The nurse is assessing a 13-year-old girl with a family history of kidney cancer who has come to the clinic complaining of abdominal pain, nausea, and vomiting. Which of the following findings would the nurse identify as least likely indicative of cancer in a child?

A) The child reports rectal bleeding and diarrhea.
B) Observation reveals an asymmetric abdomen.
C) The child experiences a broken bone without trauma.
D) Palpation determines an abdominal mass.

Question 35

The nurse is caring for a 9-year-old boy who is having chemotherapy. The nurse is developing a teaching plan for the child and family about nutrition. Which of the following would the nurse be least likely to include?

A) Emphasizing the intake of grains, fruits, and vegetables
B) Featuring high-fiber foods if opioid analgesics are being taken
C) Concentrating on consuming primarily high-calorie shakes and puddings
D) Avoiding milk products if diarrhea is a problem

Question 36

The nurse is caring for a 7-year-old girl who is undergoing a stem cell transplant. Which of the following would the nurse include in the child's postoperative plan of care?

A) Assessing for petechiae, purpura, bruising, or bleeding
B) Limiting blood draws to the minimum volume required
C) Administering antiemetics around the clock as ordered
D) Monitoring for severe diarrhea and maculopapular rash

Question 37

The nurse is caring for a 5-year-old boy undergoing radiation treatment for a neuroblastoma. Which nursing diagnosis would be most applicable for this child?

A) Activity intolerance related to anemia and weakness from medications
B) Impaired skin integrity related to desquamation from cellular destruction
C) Impaired oral mucosa related to the presence of oral lesions from malnutrition
D) Imbalanced nutrition, less than body requirements related to nausea and vomiting

Question 38

The nurse is planning a discussion group for parents with children who have cancer. Which of the following would the nurse include when describing the differences between cancer in children and adults?

A) Most childhood cancers affect the tissues rather than organs.
B) Childhood cancers are usually localized when found.
C) Unlike adult cancers, childhood cancers are less responsive to treatment.
D) The majority of childhood cancers can be prevented.

Question 39

A child is receiving fluorouracil as part of a chemotherapy protocol. Which of the following would be most important for the nurse to include in the child's plan of care?

A) Monitoring for visual changes
B) Maintaining adequate hydration
C) Using prescribed eye drops to prevent conjunctivitis
D) Avoiding administration with food or meals

Question 40

A child diagnosed with stage IV neuroblastoma has undergone abdominal surgery to remove the tumor. He is now receiving chemotherapy. Which nursing diagnosis would be most important?

A) Risk for infection related to chemotherapy
B) Impaired skin integrity related to abdominal surgery
C) Grieving related to advanced disease and poor prognosis
D) Imbalanced nutrition related to adverse effects of chemotherapy

Question 41

Which of the following would be most appropriate to include in the plan of care for a child who has undergone surgery for removal of an astrocytoma?

A) Elevating the foot of the bed
B) Positioning the child on his unaffected side
C) Raising the head of the bed at least 45 degrees
D) Administering large volumes of intravenous fluids

Question 42

Which test result would the nurse least likely expect to find in a child diagnosed with Wilms tumor?

A) Complete blood count (CBC) within normal limits
B) Urinalysis positive for blood
C) Mass on kidney
D) Elevated homovanillic acid (HVA) with 24-hour urine collection

Question 43

The nurse is describing the phases of treatment to a child who was diagnosed with leukemia and his parents. The nurse explains the induction stage as which of the following?

A) Intense therapy to strengthen remission
B) Rapid promotion of complete remission
C) Elimination of all residual leukemic cells
D) Reduction of risk for central nervous system (CNS) disease

Question 44

A 14-year-old boy is diagnosed with Hodgkin disease. When palpating for enlarged lymph nodes, the nurse would expect to find which nodes as most commonly enlarged? Select all answers that apply.

A) Cervical
B) Axillary
C) Supraclavicular
D) Occipital
E) Inguinal

Question 45

A child is receiving methotrexate as part of his chemotherapy protocol. The nurse would anticipate administering which agent to counteract the toxic effects of methotrexate?

A) Mesna
B) Cyclosporine
C) Leucovorin
D) Nystatin

Question 46

A group of nursing students are reviewing the various drug classes used for cancer chemotherapy. The students demonstrate an understanding of these classes when they identify which agent as an example of a nitrosourea?

A) Busulfan
B) Thiotepa
C) Cisplatin
D) Carmustine

Question 47

The nurse is developing a plan of care for a child who is receiving cyclophosphamide. Which of the following would the nurse expect to include?

A) Withholding food and fluids from the child during the infusion
B) Encouraging frequent voiding during and after the infusion
C) Monitoring for signs of anaphylaxis during infusion
D) Assessing the child for complaints of bone pain

Question 48

The nurse is reviewing the laboratory test results of a child who is receiving chemotherapy. To calculate the child's absolute neutrophil count, in addition to the total number of white blood cells, which results would the nurse use? Select all answers that apply.

A) Bands
B) Segs
C) Eosinophils
D) Basophils

Question 49

A nurse is instituting neutropenic precautions for a child. Which of the following would the nurse most likely include? Select all answers that apply.

A) Placing the child in a semiprivate room
B) Avoiding rectal exams, suppositories, and enemas
C) Placing a mask on the child when outside the room
D) Encouraging an intake of raw fruits and vegetables
E) Discouraging fresh flowers in the child's room.

Question 50

A child is scheduled to undergo radiation therapy as part of his treatment plan for newly diagnosed cancer. After teaching the child and parents about this treatment, the nurse determines that additional teaching is needed when the parents state which of the following?

A) "We should not wash off the markings on his skin."
B) "He can use petroleum jelly if the skin becomes reddened."
C) "He needs to use a sunscreen with an SPF of 30 or more."
D) "He should not apply deodorant to the treatment site."