Question 1

The parents of a child with cancer tell the nurse that a bone marrow transplant (BMT)may be necessary.What should the nurse recognize as important when discussing this with the family?

Accepted Answer

The most successful BMTs come from suitable HLA-matched donors.The timing of a BMT depends on the disease process involved.It usually follows intensive high-dose chemotherapy and/or radiation therapy.Usually parents only share approximately 50% of the genetic material with their children.A one-in-four chance exists that two siblings will have two identical haplotypes and will be identically matched at the HLA loci.Discussing the continuation of chemotherapy or radiotherapy is not appropriate when planning the BMT.That decision will be made later.

Question 2

An 8-year-old girl is receiving a blood transfusion when the nurse notes that she has developed precordial pain,dyspnea,distended neck veins,slight cyanosis,and a dry cough.These manifestations are most suggestive of:

Accepted Answer

The signs of circulatory overload include distended neck veins,hypertension,crackles,dry cough,cyanosis,and precordial pain.Signs of air embolism are sudden difficulty breathing,sharp pain in the chest,and apprehension.Allergic reactions are manifested by urticaria,pruritus,flushing,asthmatic wheezing,and laryngeal edema.Hemolytic reactions are characterized by chills,shaking,fever,pain at infusion site,nausea,vomiting,tightness in chest,flank pain,red or black urine,and progressive signs of shock and renal failure.

Question 3

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

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 DPT are not live virus vaccines.

Question 4

What is the most common mode of transmission of human immunodeficiency virus (HIV)in the pediatric population?

Accepted Answer

Perinatal transmission accounts for the highest percentage (91%)of HIV infections in children.Infected women can transmit the virus to their infants across the placenta during pregnancy,at delivery,and through breastfeeding.Cases of HIV infection from sexual abuse have been reported; however,perinatal transmission accounts for most pediatric HIV infections.In the past some children became infected with HIV through blood transfusions; however,improved laboratory screening has significantly reduced the probability of contracting HIV from blood products.Poor hand washing is not an etiology of HIV infection.

Question 5

Which child should the nurse document as being anemic?

Accepted Answer

Anemia is a condition in which the number of red blood cells,or hemoglobin concentration,is reduced below the normal values for age.Anemia is defined as a hemoglobin level below 10 or 11 g/dL.The child with a hemoglobin of 10 g/dL would be considered anemic.The normal hemoglobin for a child after 2 years of age is 11.5 to 15.5 g/dL.

Question 6

Children receiving long-term systemic corticosteroid therapy are most at risk for:

Accepted Answer

Growth delay is associated with long-term steroid use.Hypertension is a clinical manifestation of long-term systemic steroid administration.Dilation of blood vessels in the cheeks is associated with an excess of topically administered steroids.Increased appetite and weight gain are clinical manifestations of excess systemic corticosteroid therapy.

Question 7

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

Accepted Answer

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

Question 8

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

Accepted Answer

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

Question 9

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

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.Encouraging the child to remain NPO will help with this episode,but the child will have the discomfort and be at risk for dehydration.Administering an antiemetic after the child has nausea does not avoid anticipatory nausea.

Question 10

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

Accepted Answer

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

Question 11

The nurse is planning care for an adolescent with acquired immunodeficiency syndrome.The priority nursing goal is to:

Accepted Answer

As a result of the immunocompromise that is associated with human immunodeficiency virus 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.Restoring immunologic defenses 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 12

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

Accepted Answer

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

Question 13

The nurse is planning activity for a 4-year-old child with anemia.Which activity should the nurse plan for this child?

Accepted Answer

Because the basic pathologic process in anemia is a decrease in oxygen-carrying capacity,an important nursing responsibility is to assess the child's energy level and minimize excess demands.The child's level of tolerance for activities of daily living and play is assessed,and adjustments are made to allow as much self-care as possible without undue exertion.Puppet play in the child's room would not be overly tiring.Hide and seek,dancing,and walking to the lobby would not conserve the anemic child's energy.

Question 14

Myelosuppression associated with chemotherapeutic agents or some malignancies such as leukemia can cause bleeding tendencies because of a/an:

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 15

What is the priority nursing intervention for a child hospitalized with hemarthrosis resulting from hemophilia?

Accepted Answer

Immobilization and elevation of the joint will prevent further injury until bleeding is resolved.Although acetaminophen may help with pain associated with the treatment of hemarthrosis,it is not the priority nursing intervention.Assessment of a child's response to hospitalization is relevant to all hospitalized children; however,in this situation,psychosocial concerns are secondary to physiologic concerns.A priority nursing concern for this child is the management of hemarthrosis.Assessing the impact of hospitalization on the family system is relevant to all hospitalized children; however,it is not the priority in this situation.

Question 16

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

Accepted Answer

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

Question 17

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

Accepted Answer

The children should be carefully evaluated before giving 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,pneumococcus,and inactivated poliovirus are not live vaccines.

Question 18

An inherited immunodeficiency disorder characterized by absence of both humoral and cell-mediated immunity is:

Accepted Answer

Severe SCIDS is a genetic disorder that results in deficits of both humoral and cellular immunity.Acquired immunodeficiency syndrome is not inherited.Wiskott-Aldrich syndrome is an X-linked recessive disorder with selected deficiencies of T and B lymphocytes.Fanconi syndrome is a hereditary disorder of red cell production.

Question 19

A common clinical manifestation of Hodgkin's disease is:

Accepted Answer

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

Question 20

Several complications can occur when a child receives a blood transfusion.An immediate sign or symptom of an air embolus is:

Accepted Answer

Signs of air embolism are sudden difficulty breathing,sharp pain in the chest,and apprehension.Air emboli should be avoided by carefully flushing all tubing of air before connecting to the patient.Chills,shaking,nausea,and vomiting are associated with hemolytic reactions.Irregular heart rate is associated with electrolyte disturbances and hypothermia.

Quiz 43: Hematologic and Immunologic Dysfunction

The parents of a child with cancer tell the nurse that a bone marrow transplant (BMT) may be necessary.What should the nurse recognize as important when discussing this with the family?