KEYWORDS
Aplastic anemia
Beta-thalassemia (Cooley anemia or thalassemia major)
Central nervous system prophylaxis Chelation therapy
Factor VIII deficiency Hemarthrosis Hemophilia A Hodgkin disease Immunosuppressive Intrathecal chemotherapy Leukemia
Mucositis Neuroblastoma Neutropenia
Non-Hodgkin lymphoma Osteosarcoma
Pancytopenia Polycythemia Polycythemia vera Purpura
Reed-Sternberg cells
Sickle cell disease (sickle cell anemia) Splenic sequestration
Thrombocytopenia Vaso-occlusive crises Von Willebrand disease Wilms tumor
ABBREVIATIONS
Acute lymphoblastic leukemia (ALL) Cytomegalovirus (CMV)
Idiopathic thrombocytopenic purpura (ITP)
Pneumocystis carinii pneumonia or Pneumocystic pneumonia (PCP)
Severe combined immunodeficiency disease (SCID)
Vanillylmandelic acid (VMA)
QUESTIONS
1. The nurse is taking care of a child with sickle cell disease. The nurse is aware that which of the following problems is (are) associated with sickle cell disease? Select all that apply.
1. Polycythemia.
2. Hemarthrosis.
3. Aplastic crisis.
4. Thrombocytopenia.
5. Splenic sequestration.
6. Vaso-occlusive crisis.
2. An 18-month-old male is brought to the clinic by his mother. His height is in the 50th percentile, and weight is in the 80th percentile. The child is pale. The physical examination is normal, but his hematocrit level is 20%. Which of the following questions should assist the nurse in making a diagnosis? Select all that apply.
1. “How many bowel movements a day does your child have?”
2. “How much did your baby weigh at birth?”
3. “What does your child eat every day?”
4. “Has the child been given any new medications?”
5. “How much milk does your child drink per day?”
3. Which of the following factors need(s) to be included in a teaching plan for a child with sickle cell anemia? Select all that apply.
1. The child needs to be taken to a physician when sick.
2. The parent should make sure the child sleeps in an air-conditioned room.
3. Emotional stress should be avoided.
4. It is important to keep the child well hydrated.
5. It is important to make sure the child gets adequate nutrition.
4. A nurse is caring for a 5-year-old with sickle cell vaso-occlusive crisis. Which of the following orders should the nurse question? Select all that apply.
1. Position the child for comfort.
2. Apply hot packs to painful areas.
3. Give Demerol 25 mg intravenously every 4 hours as needed for pain.
4. Restrict oral fluids.
5. Apply oxygen per nasal cannula to keep oxygen saturations above 94%.
5. A nurse is caring for a child with von Willebrand disease. The nurse is aware that which of the following is a (are) clinical manifestation(s) of von Willebrand disease?
Select all that apply.
1. Bleeding of the mucous membranes.
2. The child bruises easily.
3. Excessive menstruation.
4. The child has frequent nosebleeds.
5. Elevated creatinine levels.
6. The child has a factor IX deficiency.
6. A child with hemophilia A fell and injured a knee while playing outside. The knee is swollen and painful. Which of the following measures should be taken to stop the bleeding? Select all that apply.
1. The extremity should be immobilized.
2. The extremity should be elevated.
3. Warm moist compresses should be applied to decrease pain.
4. Passive range-of-motion exercises should be administered to the extremity.
5. Factor VIII should be administered.
7. Which of the following activities should a nurse suggest for a client diagnosed with hemophilia? Select all that apply.
1. Swimming.
2. Golf.
3. Hiking.
4. Fishing.
5. Soccer.
8. Which of the following describe(s) ITP? Select all that apply.
1. ITP is a congenital hematological disorder.
2. ITP causes excessive destruction of platelets.
3. Children with ITP have normal bone marrow.
4. Platelets are small in ITP.
5. Purpura is observed in ITP.
9. The nurse is caring for a child who is receiving a transfusion of packed red blood cells. The nurse is aware that if the child had a hemolytic reaction to the blood, the signs and symptoms would include which of the following? Select all that apply.
1. Fever.
2. Rash.
3. Oliguria.
4. Hypotension.
5. Chills.
10. The nurse is caring for a child with leukemia. The nurse should be aware that children being treated for leukemia may experience which of the following complications?
Select all that apply.
1. Anemia.
2. Infection.
3. Bleeding tendencies.
4. Bone deformities.
5. Polycythemia.
11. Which of the following is a (are) reason(s) to do a spinal tap on a child with a diagnosis of leukemia? Select all that apply.
1. Rule out meningitis.
2. Assess the central nervous system for infiltration.
3. Give intrathecal chemotherapy.
4. Determine increased intracranial pressure.
5. Stage the leukemia.
12. Nausea and vomiting are common adverse effects of radiation and chemotherapy.
Which of the following measures should the nurse implement to help with the nausea and vomiting? Select all that apply.
1. Give an antiemetic 30 minutes prior to the start of therapy.
2. Continue the antiemetic as ordered until 24 hours after the chemotherapy is complete.
3. Remove food that has a lot of odor.
4. Keep the child on a nothing-by-mouth status.
5. Wait until the nausea begins to start the antiemetic.
13. Which of the following can be manifestations of leukemia in a child? Select all that apply.
1. Leg pain.
2. Fever.
3. Excessive weight gain.
4. Bruising.
5. Enlarged lymph nodes.
14. Which of the following can lead to a possible diagnosis of human immunodeficiency virus in a child? Select all that apply.
1. Repeated respiratory infections.
2. Intermittent diarrhea.
3. Excessive weight gain.
4. Irregular heartbeat.
5. Poor weight gain.
15. A nurse is caring for a 15-year-old who has just been diagnosed with non-Hodgkin lymphoma. Which of the following should the nurse include in teaching the parents about this lymphoma? Select all that apply.
1. The malignancy originates in the lymphoid system.
2. The presence of Reed-Sternberg cells in the biopsy is considered diagnostic.
3. Mediastinal involvement is typical.
4. The disease is diffuse rather than nodular.
5. Treatment includes chemotherapy and radiation.
16. The nurse is caring for a child with sickle cell anemia who has a vaso-occlusive crisis.
Which of the following interventions should improve tissue perfusion?
1. Limiting oral fluids.
2. Administering oxygen.
3. Administering antibiotics.
4. Administrating analgesics.
17. The nurse is caring for a child with sickle cell disease who is scheduled to have a splenectomy. What information should the nurse explain to the parents regarding the reason for a splenectomy?
1. To decrease potential for infection.
2. To prevent splenic sequestration.
3. To prevent sickling of red blood cells.
4. To prevent sickle cell crisis.
18. Which of the following analgesics is most effective for a child with sickle cell pain crisis?
1. Demerol.
2. Aspirin.
3. Morphine.
4. Excedrin.
19. The nurse is caring for a child with sickle cell anemia who is scheduled to have an exchange transfusion. What information should the nurse teach the family?
1. The procedure is done to prevent further sickling during a vaso-occlusive crisis.
2. The procedure reduces side effects from blood transfusions.
3. The procedure is a routine treatment for sickle cell crisis.
4. Once the child’s spleen is removed, it is necessary to do exchange transfusions.
20. A nurse instructs the parent of a child with sickle cell anemia about factors that might precipitate a pain crisis in the child. Which of the following factors identified by the parent as being able to cause a pain crisis indicates a need for further instruction?
1. Infection.
2. Overhydration.
3. Stress at school.
4. Cold environment.
21. A 10-year-old with severe factor VIII deficiency falls, injures an elbow, and is brought to the ER. The nurse should prepare which of the following?
1. An injection of factor VIII.
2. An intravenous infusion of factor VIII.
3. An injection of desmopressin.
4. An intravenous infusion of platelets.
22. Which of the following will be abnormal in a child with the diagnosis of hemophilia?
1. The platelet count.
2. The hemoglobin level.
3. The white blood cell count.
4. The partial thromboplastin time.
23. A nurse is reviewing home care instruction with the parent of a child diagnosed with hemophilia. Which of the following activities should the nurse suggest to the parent as a safe activity for the child?
1. Baseball.
2. Swimming.
3. Soccer.
4. Football.
24. Which of the following measures should the nurse teach the parent of a child with hemophilia to do first if the child sustains an injury to a joint causing bleeding?
1. Give the child a dose of Tylenol.
2. Immobilize the joint, and elevate the extremity.
3. Apply heat to the area.
4. Administer factor per the home care protocol.
25. Which of the following measures should be implemented for a child with von Willebrand disease who has a nosebleed?
1. Apply pressure to the nose for at least 10 minutes.
2. Have the child lie supine and quiet.
3. Avoid packing of the nostrils.
4. Encourage the child to swallow frequently.
26. A nurse educator is providing a teaching session for the nursing staff. Which of the fol-lowing individuals is at greatest risk for developing beta-thalassemia (Cooley anemia)?
1. A child of Mediterranean descent.
2. A child of Mexican descent.
3. A child whose mother has chronic anemia.
4. A child of American descent who has a low intake of iron.
27. A nurse is doing discharge education with a parent who has a child with beta-thalassemia (Cooley anemia). The nurse informs the parent that the child is at risk for which of the following conditions?
1. Hypertrophy of the thyroid.
2. Polycythemia vera.
3. Thrombocytopenia.
4. Chronic hypoxia and iron overload.
28. The nurse is caring for a child diagnosed with thalassemia major who is receiving the first chelation therapy. What information should the nurse teach the parent regarding the therapy?
1. Decreases the risk of bleeding.
2. Eliminates excess iron.
3. Prevents further sickling of the red blood cells.
4. Provides an iron supplement.
29. The nurse is caring for a child with ITP with a platelet count of 5000/mm3. Which of the following should the nurse administer?
1. Platelets.
2. Intravenous immunoglobulin.
3. Packed red blood cells.
4. White blood cells.
30. Which test provides a definitive diagnosis of aplastic anemia?
1. Complete blood count with differential.
2. Bone marrow aspiration.
3. Serum IgG levels.
4. Basic metabolic panel.
31. The nurse is caring for a child with a diagnosis of ALL who is receiving chemotherapy.
The nurse notes that the child’s platelet count is 20,000/mcL. Based on this laboratory finding, what information should the nurse provide to the child and parents?
1. A soft toothbrush should be used for mouth care.
2. Isolation precautions should be started immediately.
3. The child’s vital signs, including blood pressure, should be monitored every 4 hours.
4. All visitors should be discouraged from coming to see the family.
32. A 5-year-old is admitted to the hospital with complaints of leg pain and fever. On physical examination, the child is pale and has bruising over varies area of the body.
The physician suspects that the child has ALL. The nurse informs the parent that the diagnosis will be confirmed by which of the following?
1. Lumbar puncture.
2. White blood cell count.
3. Bone marrow aspirate.
4. Bone scan.
33. The nurse is caring for a 10-year-old with leukemia who is receiving chemotherapy.
The child is on neutropenic precautions. Friends of the child come to the desk and ask for a vase for flowers they have picked from their garden. Which of the following is the best response?
1. “I will get you a special vase that we use on this unit.”
2. “The flowers from your garden are beautiful but should not be placed in the room at this time.”
3. “As soon as I can wash a vase, I will put the flowers in it and bring it to the room.”
4. “Get rid of the flowers immediately. You could harm the child.”
34. The nurse is discharging a child who has just received chemotherapy for neuroblas-toma. Which of the following statements made by the child’s parent indicates a need for additional teaching?
1. “I will inspect the skin often for any lesions.”
2. “I will do mouth care daily and monitor for any mouth sores.”
3. “I will wash my hands prior to caring for my child.”
4. “I will take a rectal temperature daily and report a temperature greater than 101°F (38.3°C) immediately to the physician.”
35. The child for whom you are caring is to have a bone marrow aspiration. Which intervention should the nurse implement after the procedure?
1. Ask the child to remain in a supine position.
2. Place the child in an upright position for 4 hours.
3. Keep the child nothing by mouth for 6 hours.
4. Administer analgesics as needed for pain.
36. The nurse is caring for a child who is newly diagnosed with leukemia. When discussing the medical treatment plan for this child with the parents, the nurse informs them that the central nervous system needs to be protected from the invasion of malignant cells.
Which of the following should be done to protect the central nervous system?
1. Cranial and spinal radiation.
2. Intravenous steroid therapy.
3. Intrathecal chemotherapy.
4. High-dose intravenous chemotherapy.
37. A child with leukemia is receiving chemotherapy and is complaining of nausea. The nurse has been giving the scheduled antiemetic. Which of the following should the nurse do when the child is nauseated?
1. Encourage low-protein foods.
2. Encourage low-caloric foods.
3. Offer the child’s favorite foods.
4. Offer cool, clear liquids.
38. Children with cancer often have a body image disturbance related to hair loss, moon face, or debilitation. Which of the following interventions is most appropriate?
1. Encourage them to wear a wig similar to their own hairstyle.
2. Emphasize the benefits of the therapy they are receiving.
3. Have them play only with other children with cancer.
4. Use diversional techniques to avoid discussing changes in the body because of the chemotherapy.
39. The nurse receives a call from a parent of a child with leukemia in remission. The parent says the child has been exposed to chickenpox. The child has never had chickenpox. Which of the following responses is most appropriate for the nurse?
1. “You need to monitor the child’s temperature frequently and call back if the temperature is greater than 101°F (38.3°C).”
2. “At this time there is no need to be concerned.”
3. “You need to bring the child to the clinic for a chickenpox immunoglobulin vaccine.”
4. “Your child will need to be isolated for the next 2 weeks.”
40. The nurse is caring for a child being treated for ALL. Laboratory results indicate that the child has a white blood cell count of 5000, with 5% polys and 3% bands.
Which of the following responses is most appropriate?
1. The absolute neutrophil count is 400/mm3, and the child is neutropenic.
2. The absolute neutrophil count is 5800/ mm3, and the child is not neutropenic.
3. The absolute neutrophil count is 4000/ mm3, and the child is not neutropenic.
4. The absolute neutrophil count is 800/ mm3, and the child is neutropenic.
41. Children who become immunosuppressed from chemotherapy need to be protected from infection. Which of the following is the best method to prevent the spread of infection?
1. Administer antibiotics prophylactically to the children.
2. Have people wash their hands prior to contact with the children.
3. Assign the same nurses to care for the children each day.
4. Limit visitors to family members only.
42. The mother of a child who is newly diagnosed with ALL asks the nurse “What is the prognosis?” Which of the following is correct regarding prognostic factors for determining survival for such a child?
1. The initial white blood cell count on diagnosis.
2. The race of the child.
3. The amount of time needed to initiate treatment.
4. The allergy history of the child.
43. A child diagnosed with leukemia is receiving allopurinol as part of the treatment plan. The parents asks why their child is receiving this medication. What information about the medication should the nurse provide?
1. Helps reduce the uric acid level caused by cell destruction.
2. Used to make the chemotherapy work better.
3. Given to reduce the nausea and vomiting associated with chemotherapy.
4. Helps decrease pain in the bone marrow.
44. Prednisone is given to children who are being treated for leukemia. Why is this medication given as part of the treatment plan?
1. Enhances protein metabolism.
2. Enhances sodium excretion.
3. Increases absorption of the chemotherapy.
4. Destroys abnormal lymphocytes.
45. Which of the following best describes the action of chemotherapeutic agents used in the treatment of cancer in children?
1. Suppress the function of normal lymphocytes in the immune system.
2. Are alkylating agents and are cell-specific.
3. Cause a replication of DNA and are cell-specific.
4. Interrupt cell cycle, thereby causing cell death.
46. A child has completed treatment for leukemia and comes to the clinic with the par-ents for a checkup. The parpar-ents express to the nurse that they are glad their child has been cured of cancer and is safe from getting cancer later in life. Which of the following should the nurse consider in responding?
1. Childhood cancer usually instills immunity to all other cancers.
2. Children surviving one cancer are at higher risk for a second cancer.
3. The child may have a remission of the leukemia but is immune to all other cancers.
4. As long as the child continues to take steroids, there will be no other cancers.
47. A teen is seen in clinic for a possible diagnosis of Hodgkin disease. The nurse is aware that which of the following symptoms should make the physicians suspect Hodgkin disease?
1. Fever, fatigue, and pain in the joints.
2. Anorexia with weight loss.
3. Enlarged, painless, and movable lymph nodes in the cervical area.
4. Enlarged liver with jaundice.
48. Which of the following confirms a diagnosis of Hodgkin disease in a 15-year-old?
1. Reed-Sternberg cells in the lymph nodes.
2. Blast cells in the blood.
3. Lymphocytes in the bone marrow.
4. VMA in the urine.
49. The parent of a teen with a diagnosis of Hodgkin disease asks what the child’s prognosis will be with treatment. What information should the nurse give to the parent and child?
1. Clinical staging of Hodgkin disease will determine the treatment; long-term survival for all stages of Hodgkin disease is excellent.
2. There is a considerably better prognosis if the client is diagnosed early and is between the ages of 5 and 11 years.
3. The prognosis for Hodgkin disease depends on the type of chemotherapy.
4. The only way to obtain a good prognosis is by chemotherapy and bone marrow transplant.
50. The nurse is caring for a child who is receiving extensive radiation as part of the treatment for Hodgkin disease. What intervention should be implemented?
1. Administer pain medication prior to the child’s going to radiation therapy.
2. Assess the child for neuropathy since this is a common side effect.
3. Provide adequate rest, as the child may experience excessive malaise and lack of energy.
4. Encourage the child to eat a low-protein diet while on radiation therapy.
51. The parent of a 4-year-old brings the child to the clinic and tells the nurse the child’s abdomen is distended. After a complete examination, a diagnosis of Wilms tumor is suspected. Which of the following is most important when doing a physical examination on this child?
1. Avoid palpation of the abdomen.
2. Assess the urine for the presence of blood.
3. Monitor vital signs, especially the blood pressure.
4. Obtain an accurate height and weight.
52. The parent of a child diagnosed with Wilms tumor asks the nurse what the treatment plan will be. The nurse explains the usual protocol for this condition. Which
information should the nurse give to the parent?
1. The child will have chemotherapy and, after that has been completed, radiation.
2. The child will need to have surgery to remove the tumor.
3. The child will go to surgery for removal of the tumor and the kidney and will then start chemotherapy.
4. The child will need radiation and later surgery to remove the tumor.
53. The nurse expects which of the following clinical manifestations in a child diagnosed with SCID?
1. Prolonged bleeding.
1. Prolonged bleeding.