Nokea
The family of a child receiving chemotherapy for leukemia should be taught to focus on which aspect(s) of the child's care? (Select all that apply.)
- A. Using a support group
- B. Stimulating appetite
- C. Maintaining adequate hydration
- D. Continuing with scheduled immunizations
- E. Reporting exposure to infectious diseases
Correct Answer: A,B,C,E
Rationale: Support groups, appetite stimulation, hydration, and infection vigilance are critical for a child on chemotherapy.
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The child receiving a transfusion complains of back pain and itching. What is the best initial action by the nurse?
- A. Notify the charge nurse.
- B. Disconnect intravenous lines immediately.
- C. Give diphenhydramine (Benadryl).
- D. Clamp off blood and keep line open with normal saline.
Correct Answer: D
Rationale: If a blood transfusion reaction occurs, the first action is to stop the blood infusion, keep the line open with normal saline, and notify the charge nurse.
Why would the nurse urge the family of a dying 12-year-old boy to include his 8-year-old sister in care? (Select all that apply.)
- A. She will feel less neglected by the parents.
- B. She can make amends for past hostilities to her brother.
- C. She will feel increased helplessness.
- D. She can express her feelings through care.
- E. She can experience being supportive of her parents and brother.
Correct Answer: A,B,D,E
Rationale: Including the sibling in care helps reduce feelings of neglect, allows expression of feelings, and fosters a sense of support and connection.
What will the nurse administer with ferrous sulfate drops when providing them to a child on the pediatric unit?
- A. With milk
- B. With orange juice
- C. With water
- D. On a full stomach
Correct Answer: B
Rationale: Vitamin C aids in the absorption of iron, whereas food and milk interfere with the absorption of iron.
The most recent blood count for a child who received chemotherapy last week shows neutropenia. What is the priority nursing diagnosis for this child?
- A. Risk for infection
- B. Risk for hemorrhage
- C. Altered skin integrity
- D. Disturbance in body image
Correct Answer: A
Rationale: The child with neutropenia is at risk for infection.
A newly married couple is seeking genetic counseling because they are both carriers of the sickle cell trait. How can the nurse best explain the children's risk of inheriting this disease?
- A. Every fourth child will have the disease; two others will be carriers.
- B. All of their children will be carriers, just as they are.
- C. Each child has a one in four chance of having the disease and a two in four chance of being a carrier.
- D. The risk levels of their children cannot be determined by this information.
Correct Answer: C
Rationale: The sickle cell gene is inherited from both parents; therefore, each offspring has a one in four chance of inheriting the disease.