Which of the following helps nurses understand how the respiratory tract in children is different from that in adults?

A.    Infants rely almost entirely on diaphragmatic-abdominal breathing.
B.    Smooth muscle development in the airways increases until about age 12 years.
C.    The configuration of the chest at birth is not as round as it becomes by adulthood.
D.    With age there is a decrease in both number of alveoli and branching of terminal bronchioles.

1. The ribs of an infant articulate with the vertebrae and sternum at a more horizontal angle. This contributes to the infant using primarily diaphragmatic-abdominal breathing.

2. Smooth muscle development at approximately 4 months of age is sufficient to respond to irritating stimuli.
3. The chest of an infant is more rounded than that of an adult.
4. Alveoli steadily increase in number. By age 12, there are nine times as many alveoli as at birth.

2. Which of the following is a measure of chest wall and lung distensibility?

A.    Resistance
B.    Ventilation
C.    Compliance
D.    Alveolar surface tension

3. Compliance is a measure of chest wall and lung distensibility.
1. Resistance increases the work of breathing. Three major sources of resistance are airway size, tissue resistance in lung, and flow resistance in the airways.
2. Ventilation is the exchange of gases in the lungs.
4. Alveolar surface tension is one of several contributory factors to compliance.
Text reference: p. 1277

3.    Which of the following blood oxygenation tests is the photometric measurement of oxygen saturation?

A.    Oximetry
B.    Capnography
C.    Arterial puncture
D.    Transcutaneous oxygen and carbon dioxide monitoring

1. Oximetry provides continuous noninvasive measurements of hemoglobin saturation. Photometric measurements are used to determine the oxygen saturation.
2. Capnography measures carbon dioxide during inhalation and exhalation.
3. Arterial puncture is the sampling method to obtain blood for gas analysis.
4. This provides a continuous and reliable trend of arterial oxygen and carbon dioxide.
Text reference: p. 1282

4.    Nursing considerations related to the administration of oxygen in an infant include which of the following?

A.    Discontinue during feedings so child can be held.
B.    Assess infant to determine how much oxygen should be given.
C.    Ensure uninterrupted delivery of the appropriate oxygen concentration.
D.    Direct oxygen flow so that it blows directly into the infant's face in a hood.

3. The nurse's responsibility is to ensure that the appropriate oxygen concentration is delivered uninterrupted.

1. Oxygen delivery needs to be continued as ordered. Most children receiving oxygen will need the supplemental oxygen during the increased energy expenditure of eating.
2. Ongoing assessment of the infant's respiratory status and oxygen saturation are necessary. Oxygen is a medication, and the amount is prescribed by the practitioner.
4. Oxygen should not blow directly on the infant. Cold air applied to the face can result in the diving reflex, which causes bradycardia and shunting of blood from the periphery to central circulation.
Text reference: p. 1287

5. The nurse is teaching a mother how to perform chest physical therapy and postural drainage on her 3-year-old child, who has cystic fibrosis. To perform percussion, the nurse should instruct her to:

A.    Strike the chest wall with a flat-hand position.
B.    Percuss before and after positioning for postural drainage.
C.    Percuss over the entire trunk anteriorly and posteriorly.
D.    Cover the skin with a shirt or gown before percussing

4. The child should wear a light shirt to protect the skin from the percussion.

1. The hand is cupped when the child's chest wall is struck.
2. Percussion is done after the position change.
3. There are identified positions and sequence for postural drainage.
Text reference: pp. 1289-1292

6.    The nurse is caring for an infant with a tracheostomy when accidental decannulation occurs. The nurse is unable to reinsert the tube. Which of the following should be the nurse's next action?

A.    Notify surgeon.
B.    Perform oral intubation.
C.    Try inserting larger tube.
D.    Try inserting smaller tube.

4. If the same size tube cannot be inserted, the nurse should try to insert a smaller tube. This will keep the stoma open.

1. The priority is to reinsert a new tracheostomy as soon as possible. The stoma is maintained open until the practitioner can evaluate.
2. The nurse should attempt to keep the tracheostomy stoma open.
3. A smaller tube is required.
Text reference: p. 1299

7.    A child is developing respiratory failure. Signs that the hypoxia is becoming severe include:

A.    Tachypnea
B.    Tachycardia
C.    Somnolence
D.    Restlessness

3. Somnolence is a late sign indicating severe hypoxia.

1, 2, and 4. These are cardinal signs of respiratory failure and are observed early.
Text reference: p. 1302

8.    An immediate intervention when an infant chokes on a piece of food would be to do which of the following?

A.    Administer mouth-to-mouth resuscitation.
B.    Open infant's mouth and perform blind finger sweep.
C.    Have infant lie quietly while a call is placed for emergency help.
D.    Position infant in a head-down, prone position, and administer five quick blows between the shoulder blades.

4. This is the correct position and procedure for an infant who had choked on a piece of food or another object.

1. This is not done. It might push the object into the lungs.
2. Blind finger sweeps are avoided in infants and children under age 8 years.
3. If the infant is choking, it is an emergency. Action must be taken.
Text reference: pp. 1311-1312

1.    A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because it:

A.    Liquefies secretions
B.    Improves oxygenation
C.    Promotes less labored ventilation
D.    Soothes inflamed mucous membranes

4. Warm or cold mist is useful to soothe the inflamed mucous membranes. Humidification is most useful when hoarseness or laryngeal involvement occurs.

1. Normal saline nose drops should be used to liquefy secretions. The mist particles do not penetrate in sufficient amounts to accomplish this.
2. There is no additional oxygen in the mist therapy commonly used for respiratory tract infections.
3. The primary effect of mist is to soothe the inflamed membranes. A reduction in swelling might ease ventilatory effort, but it is not the primary purpose of the therapy.
Text reference: p. 1

2.    What is an appropriate nursing intervention when caring for an infant with an upper respiratory tract infection and elevated temperature?

A.    Give tepid water baths to reduce fever.
B.    Encourage food intake to maintain caloric needs.
C.    Have child wear heavy clothing to prevent chilling.
D.    Give small amounts of favorite fluids frequently to prevent dehydration.

4. Preventing dehydration by small frequent feedings is an important intervention in the febrile child.

1. Tepid water baths may induce shivering, which raises temperature.
2. Food should not be forced; it may result in the child vomiting.
3. The febrile child should be dressed in light, loose clothing.
Text reference: p. 1318

3.    It is generally recommended that a child with acute streptococcal pharyngitis can return to school:

A.    When sore throat is better
B.    If no complications develop
C.    After taking antibiotics for 24 hours
D.    Three days after initial throat cultures

3. After children have taken antibiotics for 24 hours, they are no longer contagious to other children.

1. Sore throat may persist longer than 24 hours of antibiotic therapy, but the child is no longer considered contagious.
2. Complications may take days to weeks to develop.
4. Time from throat culture does not affect the contagiousness of the infection. Antibiotics must be used.
Text reference: p. 1321

4.    The most profound complication of prolonged middle ear disorders is:

A.    Loss of hearing
B.    Failure to thrive
C.    Visual impairment
D.    Tympanic membrane rupture

1. Loss of hearing is the principal functional consequences of prolonged middle ear infections. Diminished hearing has an adverse effect on the development of speech, language, and cognition.

2. During the active infection, loss of appetite typically occurs, and sucking or chewing tends to aggravate the pain. This is a short-term issue; when the otitis media resolves, the child resumes previous dietary intake.
3. Ear infections do not have an effect on vision.
4. Rupture of the eardrum may occur, but the loss of hearing and subsequent effect on speech are of greater concern.
Text reference: p. 1326

When planning care for a 4-month-old child admitted with respiratory distress caused by respiratory syncytial virus (RSV) and bronchiolitis, it is essential to include which of the following?

A.    Give antibiotics.
B.    Ensure hydration status.
C.    Administer cough syrup.
D.    Feed 4 ounces of formula every 4 hours.

2. When respiratory distress is present, hydration is an essential consideration. Usually infants cannot take fluids by the oral route because of the difficulty breathing. Intravenous fluid administration may be necessary.

1. RSV is a virus. Antibiotics are not beneficial.
3. Cough syrup is not routinely used in RSV.
4. Although fluid and calories are important, the infant with respiratory distress is usually unable to drink this amount of fluid.
Text reference: p. 1336

An appropriate nursing intervention when caring for a child with pneumonia is which of the following?

A.    Avoid placing child on affected side.
B.    Cluster care to conserve energy.
C.    Place in Trendelenburg position.
D.    Administer antitussive agents around the clock.

2. Encouraging rest by clustering care and promoting a quiet environment is the best intervention for a child with pneumonia.

1. Lying on the affected side may promote comfort by splinting the chest and reducing pleural rubbing. The child should be positioned with the unaffected side up to promote maximum expansion.
3. Children should be placed in a semierect position or position of comfort.
4. Antitussives are usually not indicated.
Text reference: p. 1340

Skin testing for tuberculosis (TB) is recommended:

A.    Every year for all children older than 2 years
B.    Every year for all children older than 10 years
C.    Every 2 years for all children starting at age 1 year
D.    Periodically for children who reside in high-prevalence regions

4. Children who reside in high-prevalence regions for TB and who may have ongoing exposure should be tested every 2 to 3 years.

1 and 2. Annual testing is only indicated for children with human immunodeficiency virus infection and incarcerated adolescents.
3. Testing is not necessary unless exposure is likely or an underlying medical risk factor is present.
Text reference: p. 1343 (Box 32-11)

Asthma is now classified into four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Clinical features used to determine these categories include all of the following except:

A.    Lung function
B.    Associated allergies
C.    Frequency of symptoms
D.    Frequency and severity of exacerbations

2. Associated allergies are not part of the classification system used in the Guidelines for the Diagnosis and Management of Asthma.

1, 3, and 4. The clinical features that are assessed in the classification system are frequency of daytime and nighttime symptoms, frequency and severity of exacerbations, and lung function.
Text reference: p. 1355

One of the goals for children with asthma is to prevent respiratory tract infection. This is because respiratory tract infection does which of the following?

A.    Increases sensitivity to allergens
B.    Encourages exercise-induced asthma
C.    Lessens effectiveness of medications
D.    Can trigger an episode or aggravate asthmatic state

4. Viral respiratory infections can exacerbate asthma, especially in young children, whose airways are mechanically smaller and more reactive than those of older children.

1. Respiratory infections do not affect sensitivity to allergens.
2. Exercise precipitates exercise-induced asthma.
3. The respiratory infection does not lessen the effectiveness of the medications.
Text reference: p. 1370

Which statement accurately expresses the genetic implications of cystic fibrosis (CF)?

A.    It is inherited as an autosomal dominant trait.
B.    It is a genetic defect found primarily in non-Caucasian population groups.
C.    If it is present in a child, both parents are carriers of this defective gene.
D.    There is a 50% chance that siblings of an affected child will also be affected.

3. CF is an autosomal recessive gene inherited from both parents.

1. CF is inherited as an autosomal recessive, not autosomal dominant, trait.
2. CF is found primarily in Caucasian populations.
4. An autosomal recessive inheritance pattern means that there is a 25% chance a sibling will be infected, but a 50% chance a sibling will be a carrier.
Text reference: p. 1373

In providing nourishment for a child with CF, which of the following factors should the nurse keep in mind?

A.    Fats and proteins must be greatly curtailed.
B.    Diet should be high in calories and protein.
C.    Most fruits and vegetables are not well tolerated.
D.    Diet should be high in easily digested carbohydrates and fats.

2. Children with CF require a well-balanced, high-protein, high-calorie diet because of impaired intestinal absorption.

1. Fats and proteins are a necessary part of a well-balanced diet.
3. A well-balanced diet containing fruits and vegetables is important.
4. Enzyme supplementation helps digest foods; other modifications are not necessary.
Text reference: p. 1378

The nurse is assessing a child with a cardiac problem. Extremities are cool with thready pulses, and urinary output is diminished. This is most suggestive of which of the following?

A.    Increased afterload
B.    Decreased contractility
C.    Increased stroke volume
D.    Decreased cardiac output

2. Decreased contractility is suspected if the extremities are cool with thready pulses and urinary output is diminished. Certain states are known to depress contractility (e.g., hypoxia, acidosis).

1. Increased blood pressure is indicative of higher afterload.
3 and 4. These will not produce the symptoms described.
Text reference: 1440

Which of the following procedures uses high-frequency sound waves obtained by a transducer to produce an image of cardiac structures?

A.    Echocardiography
B.    Electrophysiology
C.    Electrocardiography
D.    Cardiac catheterization

1. Echocardiography uses high-frequency sound waves. The child must lie completely still. With the improvements in technology, diagnosis can sometimes be made without cardiac catheterization.

2. Electrophysiology is an invasive procedure in which catheters with electrodes are used to record the impulses of the heart directly from the conduction system.
3. Electrocardiography is a tracing of the electrical path of the depolarization action of myocardial cells.
4. This is an invasive procedure in which a catheter is threaded into the heart.
Text reference: 1442

Nursing interventions for the child after a cardiac catheterization would include which of the following?

A.    Allow ambulation as tolerated.
B.    Monitor vital signs every 2 hours.
C.    Assess the affected extremity for temperature and color.
D.    Check pulses above the catheterization site for equality and symmetry.

3. The involved extremity is carefully assessed for signs of complications. Pulses below the catheterization site are monitored for equality and symmetry. Temperature and color are also monitored.

1. The child is maintained on bed rest or in parent's lap for 4 to 6 hours after the procedure.
2. Initially, vital signs are taken every 15 minutes.
4. Pulses are checked distal to the catheterization site.
Text reference: 1445

Which of the following is an early sign of congestive heart failure that the nurse should recognize?

A.    Tachypnea
B.    Bradycardia
C.    Inability to sweat
D.    Increased urinary output

1. Tachypnea is one of the early signs that should be identified. Tachycardia at rest, dyspnea, retractions, and activity intolerance are other physical signs and symptoms.

2. Tachycardia, not bradycardia, is one of the symptoms suggestive of congestive heart failure.
3. The child may be diaphoretic.
4. Urinary output usually will be decreased.
Text reference: 1448

Nursing care of the infant and child with congestive heart failure would include which of the following?

A.    Force fluids appropriate to age.
B.    Monitor respirations during active periods.
C.    Organize activities to allow for uninterrupted sleep.
D.    Give larger feedings less often to conserve energy.

3. The child needs to be well rested before feeding. The child's needs should be met as quickly as possible to minimize crying. The nurse must organize care to minimize the child's energy expenditure.

1. The child who has congestive heart failure has an excess of fluid.
2. Monitoring vital signs is appropriate, but minimizing energy expenditure is a priority.
4. The child often cannot tolerate larger feedings.
Text reference: 1453

Which of the following heart defects causes hypoxemia and cyanosis because desaturated venous blood is entering the systemic circulation?

A.    Coarctation of the aorta
B.    Arterial septal defect
C.    Patent ductus arteriosus
D.    Tetralogy of Fallot

4. Tetralogy of Fallot is a cardiac defect that has a mixed blood circulation.

1. Coarctation of the aorta is an obstructive defect. There is no mixing of oxygenated and unoxygenated blood.
2 and 3. These defects have increased flow of blood to the pulmonary system. The pressure gradient allows for oxygenated blood to return to the lungs.
Text reference: 1456

Nurses counseling parents regarding the home care of the child with a cardiac defect before corrective surgery should stress which of the following?

A.    Need to be extremely concerned about cyanotic spells
B.    Importance of relaxing discipline and limit setting to prevent crying
C.    Importance of reducing caloric intake to decrease cardiac demands
D.    Desirability of promoting normality within the limits of the child's condition

4. The child needs to have social interactions, discipline, and appropriate limit setting. Parents need to be encouraged to promote as normal a life as possible for their child.

1. Because cyanotic spells will occur in children with some defects, the parents need to be taught how to manage these.
2. Child needs discipline and appropriate limits.
3. Child needs increased caloric intake.
Text reference: 1469

Which of the following is an important nursing consideration when chest tubes will be removed from a child?

A.    Explain that it is not painful.
B.    Administer analgesics before procedure.
C.    Explain that only a Band-Aid will be needed.
D.    Expect bright red drainage for several hours after removal.

2. Removal of chest tubes can be an uncomfortable, frightening experience. Analgesics should be used.

1. Children are forewarned that they will feel a sharp, momentary pain.
3. A petrolatum-covered gauze dressing is immediately applied over the wound and securely taped to the skin on all four sides to form an airtight seal.
4. No drainage is anticipated on the dressing.
Text reference: 1474

Therapeutic management of the child with rheumatic fever includes:

A.    Administration of penicillin
B.    Avoidance of salicylates (aspirin)
C.    Strict bed rest for 4 to 6 weeks
D.    Administration of corticosteroids if chorea develops

1. Penicillin remains the drug of choice (oral or intramuscular injections), with macrolides or cephalosporins as a substitute in penicillin-sensitive children. Initial therapy includes a full 10-day course of penicillin or an alternative antibiotic.

2. Salicylates may be used to reduce the inflammatory process after diagnosis.
3. Bed rest is not indicated. Children can resume regular activities after the febrile stage is over.
4. The chorea is transient, and pharmacologic intervention is not indicated.
Text reference: 1480

The primary therapy for secondary hypertension in children is:

A.    Low-salt diet
B.    Weight reduction
C.    Increased exercise and fitness
D.    Treatment of underlying cause

4. Secondary hypertension is a result of an underlying disease process or structural abnormality. It is usually necessary to treat the problem before the hypertension will be resolved.

1, 2, and 3. These therapies are usually effective for essential hypertension.
Text reference: 1487

Which of the following is an important nursing responsibility when a dysrhythmia is suspected?

A.    Order an immediate electrocardiogram.
B.    Count radial rate every 1 minute for five minutes.
C.    Count apical rate for 1 full minute and compare with radial rate.
D.    Have someone else take the radial rate simultaneously with the apical rate.

3. This is the nurse's first action. If a dysrhythmia is occurring, the radial pulse may be lower than the apical rate.

1. This may be indicated after conferring with the practitioner.
2. Radial pulse needs to be compared with the apical.
4. It is the nurse's responsibility to check both rates.
Text reference: 1493

The nurse is explaining blood components to an 8-year-old child. The nurse's best description of platelets is that they do which of the following?

A.    Make up the liquid portion of blood
B.    Help keep germs from causing infection
C.    Carry the oxygen you breathe from your lungs to all parts of your body
D.    Help your body stop bleeding by forming a clot (scab) over the hurt area

4. Platelets are involved in hemostasis.

1. This is a definition of plasma.
2. This describes the function of white blood cells.
3. This is the function of the red blood cells.
Text reference: 1511

When hemoglobin falls sufficiently to produce clinical manifestations, the signs and symptoms are due to:

A.    Phagocytosis
B.    Tissue hypoxia
C.    Pulmonary hypertension
D.    Depressed bone marrow

2. The signs and symptoms (e.g., weakness, fatigue, and a waxy pallor in severe anemia) are due to tissue hypoxia.

1. This is a function of white blood cells used in prevention of infection.
3. Pulmonary hypertension is not associated with anemia. Severe anemia may contribute to cardiac compensation.
4. This may be the cause of the low hemoglobin.
Text reference: 1510

The nurse suspects a child is having an adverse reaction to a blood transfusion. The first action by the nurse should be which of the following?

A.    Notify physician.
B.    Take vital signs and blood pressure and compare them with baseline.
C.    Dilute infusing blood with equal amounts of normal saline.
D.    Stop transfusion and maintain a patent intravenous line with normal saline and new tubing.

4. This is the priority nursing action. If an adverse reaction is occurring, it is essential to minimize the amount of blood that is infused.

1 and 2. These actions should be performed after the blood transfusion is stopped and infusion of normal saline has begun.
3. Blood should not be diluted; it should be returned to the blood bank if an adverse reaction has occurred.
Text reference: 1515

The parent of a child receiving an iron preparation tells the nurse that the child's stools are a tarry green color. The nurse should explain that this is a (an):

A.    Symptom of iron-deficiency anemia
B.    Adverse effect of the iron preparation
C.    Indicator of an iron preparation overdose
D.    Normally expected change resulting from the iron preparation

4. An adequate dosage of iron turns the stools a tarry green color.

1, 2, and 3. These descriptions are not relevant. If the stools do not become tarry green, it may be indicative of administration issues.
Text reference: 1519

The most important nursing consideration when caring for a child with sickle cell anemia is which of the following?

A.    Refer parents and child for genetic counseling.
B.    Teach parents and child how to minimize crises.
C.    Help the child and family adjust to a short-term disease.
D.    Observe for complications of multiple blood transfusions.

2. Parents need specific instructions on the need to watch for changes in the child's condition, including adequate hydration, and environmental concerns.

1. Genetic counseling is important, but teaching care of the child is a priority.
3. Sickle cell anemia is a long-term, chronic illness.
4. Multiple blood transfusions are an option for some children with sickle cell disease. The priority for all children with this condition is properly preparing the parents to care for them.
Text reference: 1527

The parents of a child hospitalized with sickle cell anemia tell the nurse that they are concerned about narcotic analgesics causing addiction. The nurse should explain which of the following concerning narcotic analgesics?

A.    They are often ordered but not usually needed.
B.    When they are medically indicated, children rarely become addicted.
C.    They are given as a last resort because of the threat of addiction.
D.    They are used only if other measures, such as ice packs, are ineffective.

2. Pain is the most common and debilitating symptom experienced by patients with sickle cell disease.

1. The chronic nature of this pain can greatly affect the child's development. A multidisciplinary approach is best for its management.
3. Patient-controlled analgesia or continuous intravenous administration is usually effective.
4. Pharmacologic intervention is necessary for the pain of sickle cell crisis.
Text reference: 1527

Chelation therapy is begun on a child with β-thalassemia major. The purpose of this therapy is to do which of the following?

A.    Treat the disease.
B.    Eliminate excess iron.
C.    Decrease risk of hypoxia.
D.    Manage nausea and vomiting.

2. Iron overload (hemosiderosis) is a complication of the blood transfusions. Chelation therapy is necessary to minimize the development of hemosiderosis and hemochromatosis.

1. Blood transfusions are the primary medical management.
3 and 4. Chelation therapy removes iron; it does not affect the disease process.
Text reference: 1533

The school nurse is caring for a child with hemophilia who fell on his arm during recess. Which of the following supportive measures should the nurse do until factor replacement therapy can be instituted?

A.    Apply warm, moist compresses.
B.    Apply tourniquet for at least 5 minutes.
C.    Elevate area above the level of the heart.
D.    Begin passive range of motion unless pain is severe.

3. The initial response should include elevation.

1. Cold should be applied to the arm. This will aid in vasoconstriction.
2. Pressure is effective in small areas, but would not work for an extremity.
4. Passive range of motion is not recommended. The child can perform active range of motion after the bleeding episode has resolved.
Text reference: 1539-1540

The school nurse is discussing prevention of acquired immunodeficiency syndrome with some adolescents. Which of the following is appropriate to include?

A.    Virus is easily transmitted.
B.    It is only transmitted through blood.
C.    Condoms should be used if adolescents are homosexual.
D.    Recreational drug users should not share needles or other equipment.

4. Human immunodeficiency virus is spread through blood and body fluids. Intravenous needles that have been used should not be shared. They may be contaminated with the virus.

1. The virus is not easily transmitted. It requires direct contact with blood or body fluids on a nonintact skin surface.
2. Body fluids may also transmit the virus.
3. Condoms should be used for both heterosexual and homosexual sex.
Text reference: 1550

The nurse stops to assist a child who has been hit by a car while riding a bicycle. Someone has activated the emergency medical system. Until paramedics arrive, the nurse should consider which of the following in caring for this child who has experienced severe trauma?

A.    Rapid assessment should begin with ABC status: airway, breathing, consciousness.
B.    Assessment should begin with area injured; assessment of other areas can wait.
C.    The possibility of spinal cord injury should be ruled out before transporting child to the hospital.
D.    Temperature maintenance is more difficult than in adults, since young children have a larger surface area related to body mass.

1. The first priority is always airway, breathing, and circulation.

2. This occurs after the child's cardiopulmonary status has been addressed.
3. Transport can occur by immobilizing the cervical spine. The head is maintained in a neutral position, and movement of the head or body is not allowed in any direction.
4. Infants have the greatest discrepancy in body surface areas. Children old enough to ride bikes have similar body proportions to adults.
Text reference: 1733

Immobilization causes which of the following effects on the cardiovascular system?

A.    Venous stasis
B.    Increased vasopressor mechanism
C.    Normal distribution of blood volume
D.    Increased efficiency of orthostatic neurovascular reflexes

1. The physiologic effects of immobilization, as a result of decreased muscle contraction, include venous stasis. This can lead to pulmonary emboli or thrombi.

2. A decreased vasopressor mechanism results in orthostatic hypotension, syncope, hypotension, decreased cerebral blood flow, and tachycardia.
3. An altered distribution of blood volume is found with decreased cardiac workload and exercise tolerance.
4. Immobilization causes a decreased efficiency of orthostatic neurovascular reflexes with an inability to adapt readily to the upright position and with pooling of blood in the extremities in the upright position.
Text reference: 1736

A young child has recently been fitted with knee, ankle, and foot orthosis (brace). Care of the skin should include which of the following?

A.    Apply lotion or cream to soften skin.
B.    Contact practitioner or orthotist if skin redness does not disappear.
C.    Place padding between skin and brace if child experiences burning sensation under brace.
D.    If small blister develops, apply rubbing alcohol and place padding between skin and brace.

2. Redness is a sign of skin irritation from the brace. The brace needs to be adjusted to be functional.

1. The skin should not be softened.
3. The brace is specially designed for the child. Padding may alter the alignment of the brace.
4. Rubbing alcohol would be painful. If the brace causes blisters, it needs to be adjusted.
Text reference: 1746

A child, age 10 years, sustained a fracture in the epiphyseal plate of her right fibula when she fell out of a tree. When discussing this injury with her parents, the nurse should consider which of the following?

A.    This type of fracture is inconsistent with a fall.
B.    Bone growth can be affected by this type of fracture.
C.    This is an unusual fracture site in young children.
D.    Healing is usually delayed in this type of fracture.

2. Detection of epiphyseal injuries is sometimes difficult, but fractures involving the epiphysis or epiphyseal plate present special problems in determining whether bone growth will be affected.

1 and 3. The epiphysis is the weakest point of the long bones. This is a frequent site of damage during trauma.
4. Healing of epiphyseal injuries is usually prompt.
Text reference: 1750

Which of the following would cause a nurse to suspect that an infection has developed under a cast?

A.    Cold toes
B.    Increased respirations
C.    Complaint of paresthesia
D.    "Hot spots" felt on cast surface

4. If hot spots are felt on the cast surface, they usually indicate infection beneath the area. This should be reported so that a window can be made in the cast to observe the site.

1. Cold toes may indicate too tight a cast and need further evaluation.
2. Increased respirations may indicate a respiratory infection or pulmonary emboli. This should be reported, and child should be evaluated.
3. The five Ps of ischemia from a vascular injury include pain, pallor, pulselessness, paresthesia, and paralysis. Paresthesia is an indication of vascular injury, not infection.
Text reference: 1757

Which of the following statements is correct regarding sports injuries during adolescence?

A.    Rapidly growing bones, muscles, joints, and tendons offer some protection from unusual strain.
B.    The increase in strength and vigor during adolescence helps prevent injuries related to fatigue.
C.    More injuries occur during organized athletic competition than during recreational sports participation.
D.    Adolescents may not possess insight and judgment to recognize when an activity is beyond their capabilities.

4. Children and adolescents may not possess insight and judgment to recognize when an activity is beyond their capabilities.

1. Rapidly growing bones, muscles, joints, and tendons are especially vulnerable to unusual strain.
2. The increase in strength and vigor in adolescence may tempt adolescents to overextend themselves.
3. More injuries occur during recreational sports participation than in organized athletic competition.
Text reference: 1766

Which of the following results when ice is applied immediately after a soft-tissue injury, such as a sprained ankle?

A.    Increases the pain threshold
B.    Increases metabolism in the tissues
C.    Produces deep tissue vasodilation
D.    Leads to release of more histamine-like substances

3. Nine to 15 minutes of ice exposure produces deep tissue vasodilation without increased metabolism.

1. Ice has a rapid cooling effect on tissues that reduces pain.
2. The decreased temperature slows metabolism, thus reducing tissue oxygen requirements.
4. Fewer histamine-like substances are released.
Text reference: 1770

A 4-year-old is newly diagnosed with Legg-Calvé-Perthes disease. Nursing considerations include which of the following?

A.    Encourage normal activity for as long as possible.
B.    Explain the cause of the disease to the child and family.
C.    Prepare child and family for long-term, permanent disabilities.
D.    Teach family the care and management of the corrective appliance.

4. The family needs to learn the purpose, function, application, and care of the corrective device and the importance of compliance to achieve the desired outcome.

1. The initial therapy is rest and non?weight-bearing activity, which help reduce inflammation and restore motion.
2. Legg-Calvé-Perthes is a disease of unknown etiology. A disturbance of circulation to the femoral capital epiphysis produces an ischemic aseptic necrosis of the femoral head.
3. The disease is self-limiting, but the ultimate outcome depends on early and efficient therapy and the age of the child at onset.
Text reference: 1779

The nurse is preparing an adolescent girl for Dwyer instrumentation to treat scoliosis. Which of the following should the nurse include?

A.    Urinary catheter may be required.
B.    Ambulation will not be allowed for up to 3 months.
C.    Surgery eliminates the need for casting and bracing.
D.    Discomfort can be controlled with nonpharmacologic methods.

1. Dwyer instrumentation is a surgical procedure. Urinary catheterization may be required, especially if epidural patient-controlled analgesia is used.

2. Ambulation is allowed as soon as possible. Depending on the instrumentation used, most patients are walking by the second or third postoperative day.
3. Casting and bracing are required postoperatively.
4. The child usually has considerable pain for the first few days after surgery. Intravenous opioids should be administered on a regular basis.
Text reference: 178

An important nursing consideration when caring for a child with juvenile rheumatoid arthritis
       would be which of the following?

A.    Apply ice packs to relieve stiffness and pain.
B.    Administer acetaminophen to reduce inflammation.
C.    Teach child and family correct administration of medications.
D.    Encourage range-of-motion exercises during periods of inflammation.

3. The management of juvenile rheumatoid arthritis is primarily pharmacologic. The family should be instructed regarding administration of medications and the value of a regular schedule of administration to maintain a satisfactory blood level in the body. They need to know that nonsteroidal antiinflammatory drugs should not be given on an empty stomach and to be alert for signs of toxicity.

1. Warm, moist heat is best for relieving stiffness and pain.
2. Acetaminophen does not have antiinflammatory effects.
4. Range-of-motion exercises should not be done during periods of inflammation.
Text reference: 1795

Chemotherapeutic drugs to treat cancer are often given in combination because:

A.    The drugs can be given by various routes.
B.    The drugs can be given at different times during the day.
C.    Patients cannot tolerate extremely high doses of single drugs.
D.    The drugs allow for optimum cell destruction with minimum toxic effects.

4. Combining drugs allows for synergistic effects. Optimum cell cycle destruction with minimum toxic effects and decreased resistance by the cancer cells to the agent are possible.

1. Routes of administration depend on the pharmacologic attributes of the drug. The routes do not influence interactions.
2. Combination therapy usually has specific intervals to maximize synergistic effect.
3. High doses of drugs are indicated in different regimens.
Text reference: 1562

Nursing considerations related to the administration of chemotherapeutic drugs include which of the following?

A.    Anaphylaxis cannot occur, since the drugs are considered toxic to normal cells.
B.    Infiltration will not occur unless superficial veins are used for the intravenous infusion.
C.    Many chemotherapeutic agents are vesicants that can cause severe cellular damage if drug infiltrates.
D.    Good hand washing is essential when handling chemotherapeutic drugs, butgloves are not necessary.

3. Chemotherapeutic agents can be extremely damaging to cells. Nurses experienced with the administration of vesicant drugs should be responsible for giving these drugs and be prepared to treat extravasations if necessary.

1. Anaphylaxis is a possibility with some chemotherapeutic and immunologic agents.
2. Infiltration and extravasations are always a risk, especially with peripheral veins.
4. Gloves are worn to protect the nurse when handling the drugs, and the hands should be thoroughly washed afterward.
Text reference: 1568

Which of the following pediatric oncologic emergencies is caused by the rapid release of intracellular metabolites during the initial treatment of some cancers?

A.    Hyperleukocytosis
B.    Overwhelming infection
C.    Acute tumor lysis syndrome
D.    Superior vena cava syndrome

3. Acute tumor lysis syndrome is caused by the rapid release of intracellular metabolites during the initial treatment of malignancies.

1. Hyperleukocytosis, a white blood cell count greater than 100,000/mm3, can be present at diagnosis. It is not a result of the treatment.
2. Infection may occur from bone marrow suppression that results from many chemotherapeutic agents.
4. Superior vena cava syndrome can occur from compression of the mediastinal structures by Hodgkin disease and non-Hodgkin lymphoma.
Text reference: 1571

The most common signs and symptoms of leukemia related to bone marrow involvement are which of the following?

A.    Petechiae, fever, fatigue
B.    Headache, papilledema, irritability
C.    Muscle wasting, weight loss, fatigue
D.    Decreased intracranial pressure, psychosis, confusion

1. Signs of infiltration of the bone marrow are petechiae from lowered platelet count, infection from the depressed number of effective leukocytes, and fatigue from the anemia.

2, 3, and 4. These are not signs of bone marrow involvement.
Text reference: 1584

A child with lymphoma is receiving extensive radiotherapy. Which of the following is the most common side effect of this treatment?

A.    Malaise
B.    Seizures
C.    Neuropathy
D.    Lymphadenopathy

1. Malaise is the most common side effect of radiotherapy. For children, the fatigue may be especially distressing because it means they cannot keep up with their peers.

2. Seizures are unlikely because irradiation would not usually involve the cranial area for treatment of lymphoma.
3. Neuropathy is a side effect of certain chemotherapeutic agents.
4. Lymphadenopathy is one of the findings of lymphoma.
Text reference: 1589

The postoperative care of a preschool child who has had a brain tumor removed should include which of the following?

A.    Colorless drainage is to be expected.
B.    Analgesics are contraindicated because of altered consciousness.
C.    Positioning is on the operative side in the Trendelenburg position.
D.    Close supervision is needed while the child is regaining consciousness.

4. The child needs to be observed closely, with careful assessment of the vital signs and monitoring for signs of increasing intracranial pressure.

1. Colorless drainage may be leakage of cerebrospinal fluid from the incision site. This needs to be reported as soon as possible.
2. Analgesics can be used for postoperative pain.
3. Child should not be positioned in Trendelenburg position postoperatively.
Text reference: 1594

Which of the following best describes a neuroblastoma?

A.    Diagnosis is usually made after metastasis occurs.
B.    It is the most common brain tumor in young children.
C.    Older children have improved likelihood of survival.
D.    Early diagnosis is usually possible because of the obvious clinical manifestations.

1. Neuroblastoma is considered a "silent" tumor. In more than 70% of cases, diagnosis is made after metastasis occurs.

2. The neuroblastoma is usually located in the abdomen.
3. Children under 1 year of age have a 75% survival rate; those older than age 1 year, only 50%.
4. Diagnosis is not usually made until other sites have been invaded by the tumor.
Text reference: 1596

Which of the following is most descriptive of the therapeutic management of osteogenic sarcoma?

A.    Intensive irradiation is the primary treatment.
B.    Amputation of affected extremity is rarely necessary.
C.    Treatment usually consists of surgery and chemotherapy.
D.    Bone marrow transplantation offers the best chance of long-term survival.

3. Optimum treatment of osteosarcoma is surgery and chemotherapy. Surgical biopsy is followed by either limb salvage or amputation and chemotherapy.

1 and 4. Radiation and bone marrow transplantation are not part of the therapy for osteosarcoma.
2. Amputation is often required when limb salvage is not possible.
Text reference: 1598

Where are Wilms tumors (nephroblastomas) located?

A.    Bone
B.    Brain
C.    Kidney
D.    Lymphatic system

3. Wilms tumor, or nephroblastoma, is the most common intraabdominal and kidney tumor of childhood.

1, 2, and 4. Wilms tumors are encapsulated and are located in the abdomen.
Text reference: 1599

An 18-month-old's mother complains that her infant seems tired and fussy even though he naps twice a day and sleeps through the night. The nurse notices that the infant is pale and clings to his mother during the health history and assessment. The nurse suspects iron deficiency anemia. Which finding supports the suspicion?
-
1  He drinks 40 to 48 oz (1,183 to 1,420 ml) of pasteurized cow's milk daily.
2  He weighed 8 lb 9 oz (3.9 kg) when he was born.
3  He's often constipated, and his stool is very dark.
4  He's in the 50th percentile for height and the 60th percentile for weight.

CORRECT     1  He drinks 40 to 48 oz (1,183 to 1,420 ml) of pasteurized cow's milk daily.

RATIONALE: A dietary history that reveals abnormally high milk intake (more than 32 oz [946 ml] of cow's milk daily) supports a diagnosis of iron deficiency anemia. Preterm infants are at greater risk for iron deficiency anemia than infants born at full weight. Constipation and dark stool are associated with iron supplements rather than iron deficiency anemia. Of infants with iron deficiency anemia, 30% to 56% are below the 10th percentile for weight when diagnosed.

A 3-year-old with thrombocytopenic purpura has a platelet level of less than 100,000/ml. This platelet count is significant because of the potential for:
-
1  seizures.
2  infection.
3  multiple thrombi.
4  hemorrhage.

  CORRECT     4  hemorrhage.

RATIONALE: A low platelet count can result in poor blood clotting and hemorrhage. The normal laboratory value for platelets in children older than 1 week is the same as for adults: 150,000 to 400,000/ml. Seizures don't result from platelets. A decreased white blood cell count (not a decreased platelet count) places the child at risk for infection. A high platelet count results in thrombi.

  An 8-month-old is brought to the emergency department with a temperature of 104.6% F (40.3% C). He's dehydrated and has right-ankle edema. He's admitted to the pediatric inpatient unit with a diagnosis of sickle cell anemia. The infant hasn't had symptoms before this age because in the first few months of life he had:
-
1  fetal hemoglobin.
2  immature liver function.
3  increased circulatory blood volume.
4  increased immunity from maternal antibodies.

  CORRECT     1  fetal hemoglobin.

  RATIONALE: Neonates are born with 60% to 90% fetal hemoglobin, which is gradually replaced by abnormal sickle hemoglobin when there is sickle cell anemia. Immature liver function doesn't protect the infant from sickle cell crisis. The infant's circulatory blood volume isn't increased. Increased immunity from maternal antibodies protects the infant from infectious diseases.

  In which circumstance is Rh immune globulin (RhoGAM) given in the postpartum period to prevent hemolytic disease in the neonate?
-
1  Rh-positive mother, Rh-positive neonate
2  Rh-positive mother, Rh-negative neonate
3  Rh-negative mother, Rh-positive neonate
4  Rh-negative mother, Rh-negative neonate

CORRECT     3  Rh-negative mother, Rh-positive neonate

  RATIONALE: RhoGAM is given to prevent the formation of Rh-positive antibodies in Rh-negative women exposed to Rh-positive blood through procedures, such as amniocentesis, or through childbirth. Rh-positive women don't develop Rh-negative antibodies if exposed to that blood type through birth or procedures such as amniocentesis. If the mother and neonate have the same Rh factor, no antibodies form.CLIENT NEEDS CATEGORY: Health promotion and maintenance

A 6-year-old child is diagnosed with iron deficiency anemia. Which nursing diagnosis is most appropriate?
-
1  Activity intolerance
2  Imbalanced nutrition: Less than body requirements
3  Ineffective tissue perfusion (peripheral)
4  Impaired parenting

CORRECT     2  Imbalanced nutrition: Less than body requirements

  RATIONALE: Iron deficiency anemia is the most common anemia of infancy and childhood, resulting from inadequate dietary intake of iron. Because this child's condition stems from nutritional deficiencies, Imbalanced nutrition: Less than body requirements is the most appropriate nursing diagnosis. Activity intolerance, Ineffective tissue perfusion (peripheral),  and Impaired parenting may or may not be appropriate for this specific child, but they don't target the health care needs of a child with iron deficiency anemia as precisely

  Which test distinguishes sickle cell anemia from sickle cell trait?
-
1  Schick test
2  Sickledex test
3  Complete blood count (CBC)
4  Hemoglobin electrophoresis

4  Hemoglobin electrophoresis

RATIONALE: The laboratory test to distinguish sickle cell anemia from sickle cell trait is called hemoglobin electrophoresis. Neither the Schick test nor a CBC provides information related to sickle cell anemia. The Schick test determines the presence of a significant quantity of diphtheria antitoxins in the blood. The Sickledex test is used to determine whether or not the child has a general sickle cell problem. If this test is positive, hemoglobin electrophoresis is done to determine which sickle cell disorder the child has.

A nurse is teaching a 14-year-old about sickle cell anemia. Which statement is correct?
-
1  "Physical exertion won't increase the risk of a sickle cell crisis."
2  "Increasing your fluid intake can help prevent a sickle cell crisis."
3  "Taking an extended trip to the mountains shouldn't be a problem."
4  "If you experience cold symptoms for more than a week, call your physician."

CORRECT     2  "Increasing your fluid intake can help prevent a sickle cell crisis."

  RATIONALE: The easiest and best way to prevent a sickle cell crisis is to increase fluid intake to eight 8-oz (240-ml) glasses of water a day. This keeps the blood diluted and prevents hemoconcentration. Physical exertion and high altitudes can increase the likelihood of sickling. Cold symptoms should be reported to the physician right away because illness can precipitate a crisis

A nurse is teaching the parents of a 7-year-old boy with hemophilia A about health promotion strategies. Which statement by the boy's mother indicates a need for further teaching?
-
1  "We don't give our son medications that contain aspirin."
2  "We've taught our son to check his urine for signs of bleeding."
3  "When our son falls, we elevate the injured area and apply ice for 24 hours."
4  "Our backyard is fenced in so I let my son and his friends play outside while I do the housework."

  CORRECT     4  "Our backyard is fenced in so I let my son and his friends play outside while I do the housework."

  RATIONALE: Outside play should be supervised, and a fence won't prevent such injuries as falls or being hit with a baseball. Restricting the use of aspirin, elevating an injured area, and checking for evidence of bleeding are all correct interventions.

A hospitalized 12-year-old is experiencing excessive bruising and oozing from a puncture site. Disseminated intravascular coagulation (DIC) is suspected. Which laboratory test results further suggest DIC?
-
1  Increased platelet count
2  Increased fibrinogen level
3  Absent fibrin split products
4  Prolonged prothrombin time (PT) and partial thromboplastin time (PTT)

  CORRECT     4  Prolonged prothrombin time (PT) and partial thromboplastin time (PTT)

  RATIONALE: DIC is a paradoxical disorder that produces increased coagulation and a bleeding defect at the same time. Children with DIC have a prolonged PT and PTT, decreased platelet count, decreased fibrinogen levels, and elevated fibrin split product levels.

  A 17-year-old is admitted to the facility in sickle cell crisis. The nurse receives an order from the physician that she believes is in error and decides to question it. What does this order say?
-
1  Restrict fluids to 800 ml/8 hours.
2  Give oxygen by face mask at 8 L/minute.
3  Type and crossmatch for 2 units of packed red blood cells (RBCs).
4  Give acetaminophen (Tylenol), 325 mg, orally every 4 to 6 hours for temperature above 101% F (38.3% C).

CORRECT     1  Restrict fluids to 800 ml/8 hours.

  RATIONALE: The adolescent should be well-hydrated to allow sickled RBCs to move freely through the blood vessels. Dehydration leads to blood stasis and further sickling. Sickle cell anemia increases the risk of hypoxia, which also promotes sickling, so oxygen is warranted. Blood replacement may be ordered to treat anemia and reduce the viscosity of the sickled blood. Inflammation related to swollen and warm joints causes fever, which is commonly treated with acetaminophen.

  A nurse is talking to parents of a 6-month-old with beta-thalassemia major. This disorder causes anemia, an enlarged spleen, and failure to thrive. The parents ask the nurse how their child developed this disorder. The nurse proceeds to explain about hereditary transmission. What type of inheritance pattern is involved in the transmission of beta-thalassemia major?
-
1  X-linked recessive
2  X-linked dominant
3  Autosomal recessive
4  Autosomal dominant

CORRECT     3  Autosomal recessive

RATIONALE: Beta-thalassemia major (insufficient hemoglobin synthesis) is an autosomal recessive disorder, which means that both parents must be carriers to produce the disorder in their child. Autosomal refers to chromosomes other than the sex chromosomes. Recessive disorders require transmission from both parents, whereas dominant disorders require an affected gene from one parent.

  A 7-year-old with hemophilia A has been treated with factor VIII after a baseball injury to his arm. The nurse tells the parents that they can give the child which medication for pain?
-
1  Aspirin
2  Indomethacin (Indocin)
3  Ibuprofen (Advil)
4  Etodolac

CORRECT     3  Ibuprofen (Advil)

RATIONALE: Ibuprofen in the form of Advil, Motrin, or Nuprin is safe to administer to children with hemophilia A. Nonsteroidal anti-inflammatory drugs, such as aspirin, indomethacin, and etodolac, shouldn't be used because they inhibit platelet function and can cause increased bleeding.

  A child with thalassemia major (Cooley's anemia) is receiving a blood transfusion. The child develops a transfusion reaction. Which action by the nurse is most appropriate?
-
1  Transfuse blood rapidly to complete the procedure.
2  Discontinue the transfusion and remove the I.V. needle.
3  Slow the drip rate and notify the physician.
4  Discontinue the transfusion but maintain the I.V. line with normal saline solution.

Discontinue the transfusion but maintain the I.V. line with normal saline solution.

  RATIONALE: If symptoms of a transfusion reaction develop, the nurse should discontinue the transfusion but maintain the I.V. line for administration of medications and fluids to counteract the allergic response. Continuing the transfusion may worsen the reaction.

Which nursing diagnosis takes priority for a child with iron deficiency anemia?
-
1  Activity intolerance related to reduced oxygen-carrying capacity of blood
2  Activity intolerance related to iron deficiency anemia
3  Ineffective tissue perfusion (cardiopulmonary) related to hypervolemia
4  Ineffective tissue perfusion (peripheral) related to skin pallor

CORRECT     1  Activity intolerance related to reduced oxygen-carrying capacity of blood

RATIONALE: Activity intolerance related to reduced oxygen-carrying capacity of blood is the most appropriate nursing diagnosis. Reduced oxygen-carrying capacity of the blood in anemia decreases the energy available for normal activity. Iron deficiency anemia is a medical diagnosis; it's inappropriate in a nursing diagnosis statement. Iron deficiency anemia doesn't result in hypervolemia, which is an increase in blood volume. Skin pallor is a sign of ineffective tissue perfusion and, therefore, is a defining characteristic, not a cause

  A nurse is giving an iron preparation to an 8-month-old. Which nursing intervention is most important?
-
1  Mix the iron preparation in the infant's milk.
2  Mix the iron preparation in the infant's juice.
3  Always give the iron preparation behind the teeth.
4  Because iron is poorly absorbed, use the I.M. route.

3  Always give the iron preparation behind the teeth.

RATIONALE: Giving the iron preparation behind the infant's teeth by using a straw or syringe will prevent staining the teeth. Never mix iron with the infant's formula or juice because drinking the mixture will stain the infant's teeth. Iron can be absorbed through the GI tract in most infants, so I.M. injections are reserved for severe cases of iron deficiency anemia when oral iron is ineffective.

  A nurse is counseling a couple, one of whom has sickle cell trait, about having children. The nurse is discussing the likelihood of having a child with sickle cell anemia. Which statement is correct?
-
1  When one parent has sickle cell anemia, there's a 50% chance that the couple will have a child with sickle cell anemia.
2  When one parent has the sickle cell trait, there's a 25% chance that the couple will have a child with sickle cell anemia.
3  When both parents have the sickle cell trait, there's a 50% chance that they'll have a child with sickle cell anemia.
4  When both parents have the sickle cell trait, there's a 25% chance that they'll have a child with sickle cell anemia.

CORRECT     4  When both parents have the sickle cell trait, there's a 25% chance that they'll have a child with sickle cell anemia.

  RATIONALE: Sickle cell anemia is an autosomal recessive disorder, which means that it's carried on an autosome, one of the 22 chromosomes in each living human cell that isn't involved in controlling a person's sex. If both parents have sickle cell trait, they're heterozygous for the trait, and they can transmit the disease to their offspring but don't have it themselves. That means there's a 25% chance that their offspring will have sickle cell anemia, a 50% chance that the child will be a carrier, and a 25% chance that the child won't inherit the trait. When only one parent has the sickle cell trait, the offspring have a 50% chance of being carriers but no chance of inheriting the disease.

A child with sickle cell anemia is being discharged after treatment for a crisis. Which instructions for avoiding future crises should the nurse provide to the child and his family? Select all that apply.
-
  Wrong     1  Avoid foods high in folic acid.
  CORRECT     2  Drink plenty of fluids.
  Wrong     3  Use cold packs to relieve joint pain.
  CORRECT     4  Report a sore throat to an adult immediately.
  Wrong     5  Restrict activity to quiet board games.
  CORRECT     6  Wash hands before meals and after playing.

  CORRECT     2  Drink plenty of fluids.

  CORRECT     4  Report a sore throat to an adult immediately.

  CORRECT     6  Wash hands before meals and after playing.

  RATIONALE: Fluids should be encouraged to prevent stasis in the bloodstream, which can lead to sickling. Sore throats and other cold symptoms should be promptly reported because they may indicate the presence of an infection, which can precipitate a crisis (red blood cells sickle and obstruct blood flow to tissues). Children with sickle cell anemia should learn appropriate measures to prevent infection, such as proper hand washing techniques and good nutrition practices. Folic acid intake should be encouraged to help support new cell growth; new cells replace fragile, sickled cells. Warm packs should be applied to provide comfort and relieve pain; cold packs cause vasoconstriction. The child should maintain an active, normal life. When the child experiences a pain crisis, he limits his own activity according to his pain level.

  A 4-year-old has recently been diagnosed with acute lymphocytic leukemia (ALL). What information about ALL should the nurse provide when educating the child's parents? Select all that apply.
-
  Wrong     1  Leukemia is a rare form of childhood cancer.
  CORRECT     2  ALL affects all blood-forming organs and systems throughout the body.
  Wrong     3  Because of the increased risk of bleeding, the child shouldn't brush his teeth.
  CORRECT     4  Adverse effects of treatment include diarrhea, alopecia, and stomatitis.
  CORRECT     5  There's a 95% chance of obtaining remission with treatment.
  Wrong     6  The child shouldn't be disciplined during this difficult time.

CORRECT     2  ALL affects all blood-forming organs and systems throughout the body.
 
  CORRECT     4  Adverse effects of treatment include diarrhea, alopecia, and stomatitis.
  CORRECT     5  There's a 95% chance of obtaining remission with treatment.

RATIONALE: In ALL, abnormal white blood cells (WBCs) proliferate, but they don't mature past the blast phase. These blast cells crowd out the healthy WBCs, red blood cells, and platelets in the bone marrow, leading to bone marrow depression. The blast cells also infiltrate the liver, spleen, kidneys, and lymph tissue. Common adverse effects of chemotherapy and radiation include nausea, vomiting, diarrhea, sleepiness, alopecia, anemia, stomatitis, mucositis, pain, reddened skin, and increased susceptibility to infection. There's a 95% chance of obtaining remission with treatment. Leukemia is the most common form of childhood cancer. Dental hygiene is important to prevent infection; using a soft toothbrush helps prevent bleeding but still provides good oral care. The child still needs appropriate discipline and limits. A lack of consistent parenting may lead to negative behaviors and fear.