Question 1

Which immunization should not be given to a child receiving chemotherapy for cancer?
A)Tetanus vaccine
B)Inactivated poliovirus vaccine
C)Diphtheria, pertussis, tetanus (DPT)
D)Measles, rubella, mumps

Accepted Answer

The vaccine used for measles,mumps,and rubella is a live virus and can result in an overwhelming infection.Tetanus vaccine,inactivated poliovirus vaccine,and diphtheria,pertussis,tetanus (DPT)are not live virus vaccines.

Question 2

Which is often administered to prevent or control hemorrhage in a child with cancer?
A)Nitrosoureas
B)Platelets
C)Whole blood
D)Corticosteroids

Accepted Answer

Most bleeding episodes can be prevented or controlled with the administration of platelet concentrate or platelet-rich plasma.Nitrosoureas,whole blood,and corticosteroids would not prevent or control hemorrhage.

Question 3

The school nurse is informed that a child with human immunodeficiency virus (HIV)will be attending school soon.Which is an important nursing intervention?
A)Carefully follow universal precautions.
B)Determine how the child became infected.
C)Inform the parents of the other children.
D)Reassure other children that they will not become infected.

Accepted Answer

Universal precautions are necessary to prevent further transmission of the disease.It is not the role of the nurse to determine how the child became infected.Informing the parents of other children and reassuring children that they will not become infected is a violation of the child's right to privacy.

Question 4

The nurse is conducting a staff in-service on childhood blood disorders.Which describes the pathology of idiopathic thrombocytopenic purpura?
A)Bone marrow failure in which all elements are suppressed
B)Deficiency in the production rate of globin chains
C)Diffuse fibrin deposition in the microvasculature
D)An excessive destruction of platelets

Accepted Answer

Idiopathic thrombocytopenic purpura is an acquired hemorrhagic disorder characterized by an excessive destruction of platelets,discolorations caused by petechiae beneath the skin,and a normal bone marrow.Aplastic anemia refers to a bone marrow-failure condition in which the formed elements of the blood are simultaneously depressed.Thalassemia major is a group of blood disorders characterized by deficiency in the production rate of specific hemoglobin globin chains.Disseminated intravascular coagulation is characterized by diffuse fibrin deposition in the microvasculature,consumption of coagulation factors,and endogenous generation of thrombin and plasma.

Question 5

A young child with human immunodeficiency virus (HIV)is receiving several antiretroviral drugs.The purpose of these drugs is to:
A)cure the disease.
B)delay disease progression.
C)prevent spread of disease.
D)treat Pneumocystis carinii pneumonia.

Accepted Answer

Although not a cure,these antiviral drugs can suppress viral replication,preventing further deterioration of the immune system and delaying disease progression.At this time,cure is not possible.These drugs do not prevent the spread of the disease.P.carinii prophylaxis is accomplished with antibiotics.

Question 6

A child with leukemia is receiving triple intrathecal chemotherapy consisting of methotrexate,cytarabine,and hydrocortisone.The purpose of this is to prevent:
A)infection.
B)brain tumor.
C)drug side effects.
D)central nervous system (CNS) disease.

Accepted Answer

For certain children,CNS prophylactic therapy is indicated.This drug regimen is used to prevent CNS leukemia and will not prevent infection or drug side effects.If the child has a brain tumor in addition to leukemia,additional therapy would be indicated.

Question 7

The nurse is planning care for an adolescent with AIDS.Which is the priority nursing goal?
A)Preventing infection
B)Preventing secondary cancers
C)Restoring immunologic defenses
D)Identifying source of infection

Accepted Answer

Because the child is immunocompromised in association with HIV infection,the prevention of infection is paramount.Although certain precautions are justified in limiting exposure to infection,these must be balanced with the concern for the child's normal developmental needs.Preventing secondary cancers is not currently possible.Current drug therapy is affecting the disease progression; although not a cure,these drugs can suppress viral replication,preventing further deterioration.Case finding is not a priority nursing goal.

Question 8

A young child with leukemia has anorexia and severe stomatitis.The nurse should suggest that the parents try which intervention?
A)Relax any eating pressures.
B)Firmly insist that child eat normally.
C)Begin gavage feedings to supplement diet.
D)Serve foods that are either hot or cold.

Accepted Answer

A multifaceted approach is necessary for children with severe stomatitis and anorexia.First,the parents should relax eating pressures.The nurse should suggest that the parents try soft,bland foods; normal saline or bicarbonate mouthwashes; and local anesthetics.The stomatitis is a temporary condition.The child can resume good food habits as soon as the condition resolves.

Question 9

Which immunization should be given with caution to children infected with human immunodeficiency virus (HIV)?
A)Influenza
B)Varicella
C)Pneumococcal
D)Inactivated poliovirus (IPV)

Accepted Answer

The children should be carefully evaluated before being given live viral vaccines such as varicella,measles,mumps,and rubella.The child must be immunocompetent and not have contact with other severely immunocompromised individuals.Influenza,pneumococcal,and inactivated poliovirus (IPV)are not live vaccines.

Question 10

Which is caused by a virus that primarily infects a specific subset of T lymphocytes,the CD4? T cells?
A)Wiskott-Aldrich syndrome
B)Idiopathic thrombocytopenic purpura
C)Acquired immunodeficiency syndrome (AIDS)
D)Severe combined immunodeficiency disease

Accepted Answer

AIDS is caused by the human immunodeficiency virus (HIV),which primarily attacks the CD4? T cells.Wiskott-Aldrich syndrome,idiopathic thrombocytopenic purpura,and severe combined immunodeficiency disease are not viral illnesses.

Question 11

The nurse is conducting a staff in-service on inherited childhood blood disorders.Which statement describes severe combined immunodeficiency syndrome (SCIDS)?
A)There is a deficit in both the humoral and cellular immunity with this disease.
B)Production of red blood cells is affected with this disease.
C)Adult hemoglobin is replaced by abnormal hemoglobin in this disease.
D)There is a deficiency of T and B lymphocyte production with this disease.

Accepted Answer

Severe combined immunodeficiency syndrome (SCIDS)is a genetic disorder that results in deficits of both humoral and cellular immunity.Wiskott-Aldrich is an X-linked recessive disorder with selected deficiencies of T and B lymphocytes.Fanconi syndrome is a hereditary disorder of red cell production.Sickle cell disease is characterized by the replacement of adult hemoglobin with an abnormal hemoglobin S.

Question 12

Which is the most effective pain-management approach for a child who is having a bone marrow aspiration?
A)Relaxation techniques
B)Administration of an opioid
C)EMLA cream applied over site
D)Conscious or unconscious sedation

Accepted Answer

Effective pharmacologic and nonpharmacologic measures should be used to minimize pain associated with procedures.For bone marrow aspiration,conscious or unconscious sedation should be used.Relaxation,opioids,and EMLA can be used to augment the conscious or unconscious sedation.

Question 13

Which is a common clinical manifestation of Hodgkin disease?
A)Petechiae
B)Bone and joint pain
C)Painful, enlarged lymph nodes
D)Enlarged, firm, nontender lymph nodes

Accepted Answer

Asymptomatic,enlarged,cervical or supraclavicular lymphadenopathy is the most common presentation of Hodgkin disease.Petechiae are usually associated with leukemia.Bone and joint pain are not likely in Hodgkin disease.The enlarged nodes are rarely painful.

Question 14

A boy with leukemia screams whenever he needs to be turned or moved.Which is the most probable cause of this pain?
A)Edema
B)Bone involvement
C)Petechial hemorrhages
D)Changes within the muscles

Accepted Answer

The invasion of the bone marrow with leukemic cells gradually causes a weakening of the bone and a tendency toward fractures.As leukemic cells invade the periosteum,increasing pressure causes severe pain.Edema,petechial hemorrhages,and changes within the muscles would not cause severe pain.

Question 15

Which is most descriptive of the pathophysiology of leukemia?
A)Increased blood viscosity occurs.
B)Thrombocytopenia (excessive destruction of platelets) occurs.
C)Unrestricted proliferation of immature white blood cells (WBCs) occurs.
D)First stage of coagulation process is abnormally stimulated.

Accepted Answer

Leukemia is a group of malignant disorders of the bone marrow and lymphatic system.It is defined as an unrestricted proliferation of immature WBCs in the blood-forming tissues of the body.Increased blood viscosity may occur secondary to the increased number of WBCs.Thrombocytopenia may occur secondary to the overproduction of WBCs in the bone marrow.The coagulation process is unaffected by leukemia.

Question 16

Myelosuppression,associated with chemotherapeutic agents or some malignancies such as leukemia,can cause bleeding tendencies because of a(n):
A)decrease in leukocytes.
B)increase in lymphocytes.
C)vitamin C deficiency.
D)decrease in blood platelets.

Accepted Answer

The decrease in blood platelets secondary to the myelosuppression of chemotherapy can cause an increase in bleeding.The child and family should be alerted to avoid risk of injury.Decrease in leukocytes,increase in lymphocytes,and vitamin C deficiency would not affect bleeding tendencies.

Question 17

The nurse is administering an IV chemotherapeutic agent to a child with leukemia.The child suddenly begins to wheeze and have severe urticaria.Which is the most appropriate nursing action?
A)Stop drug infusion immediately.
B)Recheck rate of drug infusion.
C)Observe child closely for next 10 minutes.
D)Explain to child that this is an expected side effect.

Accepted Answer

If an allergic reaction is suspected,the drug should be immediately discontinued.Any drug in the line should be withdrawn,and a normal saline infusion begun to keep the line open.Rechecking the rate of drug infusion,observing the child closely for next 10 minutes,and explaining to the child that this is an expected side effect can all be done after the drug infusion is stopped and the child is evaluated.

Question 18

A young boy will receive a bone marrow transplant (BMT).This is possible because one of his older siblings is a histocompatible donor.Which is this type of BMT called?
A)Syngeneic
B)Allogeneic
C)Monoclonal
D)Autologous

Accepted Answer

Allogeneic transplants are from another individual.Because he and his sibling are histocompatible,the BMT can be done.Syngeneic marrow is from an identical twin.There is no such thing as a monoclonal BMT.Autologous refers to the individual's own marrow.

Question 19

A school-age child with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time.Which is the most appropriate nursing action to prevent or minimize these reactions with subsequent treatments?
A)Encourage drinking large amounts of favorite fluids.
B)Encourage child to take nothing by mouth (remain NPO) until nausea and vomiting subside.
C)Administer an antiemetic before chemotherapy begins.
D)Administer an antiemetic as soon as child has nausea.

Accepted Answer

The most beneficial regimen to minimize nausea and vomiting associated with chemotherapy is to administer the antiemetic before the chemotherapy is begun.The goal is to prevent anticipatory symptoms.Drinking fluids will add to the discomfort of the nausea and vomiting.Remaining until nausea and vomiting subside will help with this episode,but the child will have the discomfort and be at risk for dehydration.Administering an antiemetic as soon as the child has nausea does not prevent anticipatory nausea.

Question 20

The nurse is preparing a child for possible alopecia from chemotherapy.Which should be included?
A)Explain to child that hair usually regrows in 1 year.
B)Advise child to expose head to sunlight to minimize alopecia.
C)Explain to child that wearing a hat or scarf is preferable to wearing a wig.
D)Explain to child that when hair regrows, it may have a slightly different color or texture.

Accepted Answer

Alopecia is a side effect of certain chemotherapeutic agents.When the hair regrows,it may be a different color or texture.The hair usually grows back within 3 to 6 months after cessation of treatment.The head should be protected from sunlight to avoid sunburn.Children should choose the head covering they prefer.

Quiz 26: The Child with Hematologic or Immunologic Dysfunction

Which immunization should not be given to a child receiving chemotherapy for cancer?

Which is often administered to prevent or control hemorrhage in a child with cancer?

The school nurse is informed that a child with human immunodeficiency virus (HIV) will be attending school soon.Which is an important nursing intervention?

The nurse is conducting a staff in-service on childhood blood disorders.Which describes the pathology of idiopathic thrombocytopenic purpura?

A young child with human immunodeficiency virus (HIV) is receiving several antiretroviral drugs.The purpose of these drugs is to:

A child with leukemia is receiving triple intrathecal chemotherapy consisting of methotrexate,cytarabine,and hydrocortisone.The purpose of this is to prevent:

The nurse is planning care for an adolescent with AIDS.Which is the priority nursing goal?

A young child with leukemia has anorexia and severe stomatitis.The nurse should suggest that the parents try which intervention?

Which immunization should be given with caution to children infected with human immunodeficiency virus (HIV) ?

Which is caused by a virus that primarily infects a specific subset of T lymphocytes,the CD4? T cells?

The nurse is conducting a staff in-service on inherited childhood blood disorders.Which statement describes severe combined immunodeficiency syndrome (SCIDS) ?

Which is the most effective pain-management approach for a child who is having a bone marrow aspiration?

Which is a common clinical manifestation of Hodgkin disease?

A boy with leukemia screams whenever he needs to be turned or moved.Which is the most probable cause of this pain?

Which is most descriptive of the pathophysiology of leukemia?

Myelosuppression,associated with chemotherapeutic agents or some malignancies such as leukemia,can cause bleeding tendencies because of a(n) :

The nurse is administering an IV chemotherapeutic agent to a child with leukemia.The child suddenly begins to wheeze and have severe urticaria.Which is the most appropriate nursing action?

A young boy will receive a bone marrow transplant (BMT) .This is possible because one of his older siblings is a histocompatible donor.Which is this type of BMT called?

A school-age child with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time.Which is the most appropriate nursing action to prevent or minimize these reactions with subsequent treatments?

The nurse is preparing a child for possible alopecia from chemotherapy.Which should be included?