ch 46 hematologic disorders Flashcards by Carmen Roque-Rosario

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 is the priority nursing diagnosis?

risk for infection related to neutropenia and immunosupression

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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. what action would be the priority?

educating the child and family about the testing procedures

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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. what intervention will best help the teen’s sense of control?

involving the boy in decisions whenever possible

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the nurse is caring for a 5 year old girl with a disseminated medulloblastoma. what intervention would be the most appropriate for this situation?

encouraging family to cry and express feelings away from the child

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

the parents report their son is vomiting and not eating well.

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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?

He takes his antibiotics twice a day

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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 finding would the nurse identify as least likely indicative of cancer in a child?

the child reports rectal bleeding a diarrhea

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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. what instruction would the nurse be least likely to include?

concentrating on consuming primarily high calorie shakes and puddings

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the nurse is caring for a 7 year old girl who is undergoing a stem cell transplant. what information would the nurse include in the child’s postop plan of care?

monitoring for severe diarrhea and maculopalpular rash

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

impaired skin integrity relating to desquamation from cellular destruction

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the nurse is planning a discussion group for parents with children who have cancer. how would the nurse describe a difference between cancer in children and adults?

most childhood cancers affect the tissues rather than organs

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a child is receiving carboplatin as part of a chemotherapy protocol. what would be most important for the nurse to include in the child’s plan of care?

maintaining adequate hydration

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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?

grieving related to advanced disease and poor prognosis

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

positioning the child on his unaffected side

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

elevated homovanillic acid (HVA) with 24 hour urine collection

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the parents bring their 4 year old son to the er. the child is receiving chemotherapy for acute lymphoblastic leukemia. the parents report that the child has become lethargic and has had significant episodes of vomiting and diarrhea. what findings would lead the nurse suspect the child may be experiencing tumor lysis syndrome? select all that apply.

-hyperkalemia
-hypocalcemia
-hyperuricemia

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the nurse is describing the phases of treatment to a child who was diagnosed with leukemia and his parents. how would the nurse describe the induction stage?

rapid promotion of complete remission

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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 that apply.

-cervical
-supraclavicular

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the nurse is preparing a presentation for a parent group about childhood cancers, focusing on brian tumors in children. what would the nurse describe as the most common type of brain tumor?

medulloblastoma

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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?

leucovorin

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 nitrosourea?

carmustine

the nurse is developing a plan of care for a child who is receiving cyclophosphamide. what advice would the nurse expect to include?

encouraging frequent voiding during and after infusion

the nurse is reviewing lab result for 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 that apply.

-bands
-segs

To calculate the absolute neutrophil count, the nurse would add together the
percentage of banded and segmented neutrophils and then multiply the total
number of white blood cells reported on the complete blood count by the sum.

a nurse is instituting neutropenic precautions for a child. what information would the nurse most likely include? select all that apply.

-avoiding rectal exams, suppositories, and enemas
-placing a mask on the child when outside the room
-discouraging fresh flowers in the child’s room

a child is scheduled to undergo radiation therapy as part of his treatment plan for newly diagnosed cancer. after teaching the child and parens about this treatment, the nurse determines that additional teaching is needed when the parents state:

“he can use petroleum jelly if the skin becomes reddened”

the nurse is conducting a physical examination of a toddler with suspected lead poisoning. lab results indicate blood lead level 52 mdc/dL. which action would the nurse expect to happen next?

repeat testing within 2 day sand prepare to begin chelation therapy as ordered

a nurse is conducting a physical examination for a 5 year old with suspected iron deficiency anemia. how would the nurse evaluate for changes in neurological function

will you show me how you walk across the room?

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?

“he can resume participation in football in 2 weeks.”

the nurse is assessing a child with suspected thalassemia. what would the nurse expect to assess?

frontal bossing

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 response indicates a need for further teaching?

my son can never take penecillin for an infection

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?

we should administer desmopressin as often as needed

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

intimate pain assessment with a standardized pain scale

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?

“since dry heat treatments of the factor began in 1986, there have been no reports of virus transmission”

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

“ i can have the nurse administer the chelation therapy if i am uncomfortable”

when evaluation the hemogram of an 8 month old infant the nurse would identify which type of hemoglobin as being the predominant type?

hemoglobin A

the nurse is evaluating the lab result of a 7 year old child with a suspected hematologic disorder. which finding would cause the nurse to be concerned?

RBC: 2.8 x 106/mm3 (normal range: 4.0 - 5.2)

when providing care to a child with aplastic anemia, which nursing diagnosis would be priority?

risk for injury

the nurse is reviewing the lab results of a child diagnosed with disseminated intravascular coagulation (DIC). what would the nurse interpret as indicative of this disorder?

positive fibrin spit products

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?

intravenous immunoglobulin

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

eosinophils 10% (normal: 0-3%)

a child with suspected sickle cell disease is schedule for a hemoglobin electrophoresis. when reviewing the child’s history, what would the nurse identify as potentially interfering with the accuracy of the results?

blood transfusion 1 month ago

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?

spooned nails

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.

-tuna -salmon -tofu -dried fruits

a child is prescribed monthly injections of vitamin B12. when developing the teaching plan for the family, the nurse would focus on what type of anemia?

pernicious anemia

a nurse is leading a discussion with a group of new mothers about newborn neutrino and it’s importance for growth and development. one of the mother’s asks, “ doesn’t the baby get iron from me before birth?” which response by the nurse is most appropriate?

“because the baby grows rapidly in the first months, he uses up what you gave him”

a 5 year old 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 a need for additional teaching?

“we will place the liquid in from of her gums, just below her teeth”

the nurse is assessing a child with aplastic anemia. what would the nurse expect to assess? select all that apply.

-ecchymoses -tachycardia -guaiac positive stool -epistaxis

the nurse is developing a plan of care for a child with thalassemia. what information would the nurse expect to include? select all that apply.

-packed RBC transfusion -deferoxamine therapy

a group of students is reviewing information about glucose-6-phosphate-dehydrogenase (G6PD) deficiency. the students demonstrate understanding of the material what as the cause of the disorder?

x linked recessive inheritance