Peds Hematology/Oncology

Match the oncological/hematological disease with its corresponding priority intervention(s). Type answer as “1a, 2b, 3c, etc”.

The nurse identifies the nursing diagnosis of risk for infection related to chemotherapy-induced immunosuppression. What would the nurse include in the teaching plan for the child and parents about reducing the child's risk? Select all that apply.

• Having the child sleep in a single bed and room

• Encouraging frequent, thorough handwashing

• Providing a low-carbohydrate, low-protein diet

• Encouraging frequent close contact with numerous visitors

• Cheering up the environment with fresh flowers and plants

A 14-year-old with thalassemia asks for your assistance in choosing her afternoon snack. Which choice is the most appropriate?

• Peanut butter with rice cake

• Small spinach salad

• Apple slices with cheddar cheese

• Small burger on wheat bun

• Egg on toast

A nurse is caring for a 6-month old patient suspected of having sickle cell anemia. What assessment & diagnostic findings does the nurse expect to see with this patient? Select all that apply.

• The infant will have a low reticulocyte count due to RBC hemolysis after sickling phase

• Hgb Electrophoresis testing should be done as it is the only accurate test to diagnose sickle cell anemia

• Labs will show a decrease in potassium due to the hemolysis of RBCs

• The infant is of African descent & recently suffered a febrile illness

• The newborn was tested using the Sickle-Turbidity Test (Sickledex) due to having both parents being a carrier

A nurse is caring for a 6-year-old hemophilia patient admitted to the pediatric unit after a slip in the home. The physician inputs new orders for care regarding the patient. Which order would the nurse question?

• Administer FFP w/in 30 minutes

• Prepare for the administration of DDAVP

• Administer IVIG within the first 24 hours

• Provide wound care using non-adhesives

• Administer ibuprofen for pain as needed

The nurse is providing education regarding infection prevention to a community group of parents with children diagnosed with oncology disorders. The nurse knows the teaching was effective when the following statements are made. Select all that apply.

• Administer varicella zoster immunoglobulin within 72 hours of exposure to chickenpox

• The child may receive live vaccines if in a high-risk environment

• Trimethoprim-sulfamethoxazole is given twice a day for 3 consecutive days

• Granulocyte colony-stimulating factor (GCSF) may be given

• IV acyclovir is given is if the child is actively infected with pneumonia

A child with leukemia received chemotherapy about 10 days ago. She presents today with a temperature of 100.4°F, an absolute neutrophil count of 500, and mild bleeding of the gums. What is the priority nursing intervention?

• Administer IV antibiotics as ordered.

• Provide vigorous oral care frequently with a firm toothbrush.

• Monitor pulse and blood pressure for changes.

• Administer packed red blood cell transfusion.

• Administer prednisone as ordered.

Which statements does the nurse understand are true regarding pediatric oncology patients who have been placed on palliative care? Select all that apply.

• Prevention & alleviation of pain is the primary goal of care

• The child should be the one in control of managing their own pain

• Aggressive dosing of analgesics may be required due to tolerance developing

• Family & friends should be allowed access to the child 24/7 while they are awake

• Meds that do not have a max dose  should be escalated, sometimes rapidly, to maintain adequate pain relief

A pediatric oncology nurse is lecturing several nursing students on the unit. After discussing the administration of chemo, what statements by the nursing students indicate the teaching was ineffective?

• “Chemo can only be prepared & administered by specially trained personnel.”

• “All dosing must be based on the patient’s BMI.”

• “PPE includes being double-gloved & wearing a non-permeable gown.”

• “Equipment must be disposed of in a puncture-resistant container / yellow chemo-bin”

The nurse is conducting a physical examination of a toddler with suspected lead poisoning. Lab results indicate blood lead level 52 mcg/dL. Which action would the nurse expect to happen next?

• Repeat testing within 2 days and prepare to begin chelation therapy as ordered

• Repeat testing within 1 week with education to decrease lead exposure

• Confirm with repeat testing in 1 month and referral to local health department

• Prepare to admit child to begin chelation therapy

• Hospitalize child & prepare for the possibility of dialysis