PEDS CH 46

The nurse is caring for a 16-year-old boy with acute myelogenous leukemia who is having chemotherapy and who has incomplete records for varicella zoster immunization. Which is the priority nursing diagnosis?

• Pain related to adverse effects of treatment verbalized by the child
• Nausea related to side effects of chemotherapy verbalized by the child
• Constipation related to the use of opioid analgesics for pain
• Risk for infection related to neutropenia and immunosuppression

The nurse is caring for an 8-year-old girl who has been diagnosed with leukemia and will have a variety of tests, including a lumbar puncture, before beginning chemotherapy. What action would be the priority?

• Applying EMLA to the lumbar puncture site
• Educating the child and family about the testing procedures
• Administering promethazine as ordered for nausea
• Educating the family about chemotherapy and its side effects

The nurse is caring for a 13-year-old boy with acute myelogenous leukemia who is experiencing feelings of powerlessness due to the effects of chemotherapy. What intervention will best help the teen's sense of control?

• Involving the boy in decisions whenever possible
• Acknowledging the boy's feelings of anger with the disease
• Providing realistic expectations of treatments and outcomes
• Recognizing abilities that are unaffected by the disease

The nurse is caring for a 5-year-old girl with a disseminated medulloblastoma. What intervention would be most appropriate for the situation?

• Providing emotional support to the parents and siblings of the child
• Recommending support groups for people whose children have cancer
• Encouraging the family to cry and express feelings away from the child.
• Educating the family about the disease, its treatments, and side effects

The nurse is assessing a 3-year-old boy whose parents brought him to the clinic when they noticed that the right side of his abdomen was swollen. What finding would suggest this child has a neuroblastoma?

• The child has a maculopapular rash on his palms.
• The parents report that their son is vomiting and not eating well.
• The parents report that their son is irritable and not gaining weight.
• Auscultation reveals wheezing with diminished lung sounds.

The nurse is educating the parents of a 4-year-old boy with a Wilms tumor who is about to have chemotherapy prior to surgery. Which statement by the parents indicates that the nurse should review the instructions about preventing infection?

• "He takes his antibiotic twice a day."
• "We check his temperature orally."
• "We keep him away from crowds."
• "He must be clean, and his teeth brushed."

The nurse is assessing a 13-year-old girl with a family history of kidney cancer who has come to the clinic complaining of abdominal pain, nausea, and vomiting. Which finding would the nurse identify as least likely indicative of cancer in a child?

• The child reports rectal bleeding and diarrhea.
• Observation reveals an asymmetric abdomen.
• The child experiences a broken bone without trauma.
• Palpation determines an abdominal mass.

The nurse is caring for a 9-year-old boy who is having chemotherapy. The nurse is developing a teaching plan for the child and family about nutrition. What instruction would the nurse be least likely to include?

• Emphasizing the intake of grains, fruits, and vegetables
• Featuring high-fiber foods if opioid analgesics are being taken
• Concentrating on consuming primarily high-calorie shakes and puddings
• Avoiding milk products if diarrhea is a problem

The nurse is caring for a 7-year-old girl who is undergoing a stem cell transplant. What information would the nurse include in the child's postoperative plan of care?

• Assessing for petechiae, purpura, bruising, or bleeding
• Limiting blood draws to the minimum volume required
• Administering antiemetics around the clock as ordered
• Monitoring for severe diarrhea and maculopapular rash

The nurse is caring for a 5-year-old boy undergoing radiation treatment for a neuroblastoma. Which nursing diagnosis would be most applicable for this child?

• Activity intolerance related to anemia and weakness from medications
• Impaired skin integrity related to desquamation from cellular destruction
• Impaired oral mucosa related to the presence of oral lesions from malnutrition
• Imbalanced nutrition, less than body requirements related to nausea and vomiting