Question 1

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 2

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

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 3

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 4

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 carinii prophylaxis is accomplished with antibiotics.

Question 5

What 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 6

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 7

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 8

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 immune deficiency is not inherited. 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.

Question 9

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

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 10

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,pneumococcal,and inactivated poliovirus are not live vaccines.

Question 11

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 patient. Chills,shaking,nausea,and vomiting are associated with hemolytic reactions. Irregular heart rate is associated with electrolyte disturbances and hypothermia.

Question 12

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 13

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 14

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 15

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 16

Nose bleeding,also known as __________________,is common in childhood. The bleeding ordinarily stops spontaneously or with minimal pressure.

Accepted Answer

The answer of Nose bleeding,also known as __________________,is common in...

Quiz 49: Hematologic and Immunologic Dysfunction

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:

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

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:

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

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

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:

A common clinical manifestation of Hodgkin's disease is:

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

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

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

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

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

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

Nose bleeding,also known as __________________,is common in childhood. The bleeding ordinarily stops spontaneously or with minimal pressure.

Quiz 49: Hematologic and Immunologic Dysfunction

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:

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

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:

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

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

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:

A common clinical manifestation of Hodgkin's disease is:

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

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

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

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

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

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

Nose bleeding,also known as __________________,is common in childhood. The bleeding ordinarily stops spontaneously or with minimal pressure.

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