NCLEX Pediatric: Oncology & Genetics Questions
Pediatric: Oncology & Genetics NCLEX Practice Questions
Question 1.
A 9-year-old boy diagnosed with leukemia has completed his first treatment with chemotherapy. When providing discharge instructions to the parents, which of the following does the nurse include?
(a) Provide a low-protein, high-carbohydrate diet
(b) Avoid fresh vegetables that are not peeled or cooked
(c) Notify the healthcare provider if his temperature is greater than 101°F (39°C)
(d) Increase use of humidifiers in the house
Answer:
(b) Avoid fresh vegetables that are not peeled or cooked
Explanation:
Leukemia is a malignant neoplastic disease which causes increased numbers of abnormal or immature leukocytes to be produced from the bone marrow and blood-forming organs, suppressing normal blood cell production. The patient is at increased risk for infection. Vegetables and fruits can harbor microorganisms which can lead to infections in the immunocompromised child. All fruits and vegetables should be peeled or cooked.
Rationale:
(a) is incorrect because a low-protein diet is not indicated in leukemia. A low-protein diet may be necessary for a patient with renal disease or phenylketonuria.
(c) is incorrect because leukemia patients may have an infectious process in the body without a significant rise in temperature. Thus, the healthcare provider should be notified for temperature greater than 100°F.
(d) is incorrect because humidifiers can harbor microorganisms and fungi, increasing the risk for infection in the home. The leukemia patient does not need increased humidity in the air.
Question 2.
A 6-year-old girl diagnosed with hemophilia type A is in the emergency room after falling off her bicycle. The nurse assesses the child and finds the knee is extensively swollen. What is the first action the nurse should perform?
(a) Initiate a peripheral IV to administer cryoprecipitate
(b) Type and crossmatch for transfusion
(c) Monitor the child’s vital signs for the first five minutes
(d) Apply an ice pack and compression dressing to the knee
Answer:
(d) Apply an ice pack and compression dressing to the knee
Explanation:
Hemophilia type A is a hereditary lack of coagulation factors which severely reduces the clotting ability of the blood. Rest, ice, compression, and elevation (RICE) should be initiated immediately to reduce swelling and bleeding into the knee, which is priority in hemophilia.
Rationale:
(a) is incorrect because prior to administering cryoprecipitate, the nurse must apply ice to the site of the injury.
(b) is incorrect because type and crossmatch is not a priority until after ice is applied to reduce blood flow to the area of injury.
(d) is incorrect because vital signs may not indicate early bleeding. The nursing priority is to reduce the likelihood of bleeding.
Question 3.
A husband and wife both have the sickle cell trait and ask the nurse about the possibility of their children inheriting sickle cell disease. What is the most appropriate response by the nurse?
(a) One child will have sickle cell disease
(b) Only male children will be affected
(c) Each pregnancy carries a 25 percent chance of the child being affected
(d) If four children are born, one will have sickle cell disease
Answer:
(c) Each pregnancy carries a 25 percent chance of the child being affected
Explanation:
Sickle cell disease is a hereditary anemia which mutates hemoglobin and distorts red blood cells to a sickle or crescent shape when oxygen levels are low. It is an autosomal recessive trait, and with both parents being carriers, there is a 25 percent chance each of their children will have sickle cell disease.
Rationale:
(a) is incorrect because there is a 25 percent chance each child will have sickle cell disease. The nurse cannot make a definitive prognosis of a single child having the disease.
(b) is incorrect because the disease can affect both male and female children.
(d) is incorrect because there is a 25 percent chance each child will have sickle cell disease, but this is not a guarantee that one of four children will definitively develop the disease.
Question 4.
The nurse is teaching the parents of a 6-year-old girl with sickle cell disease. When addressing sickle cell crisis, which of the following should the nurse include?
(a) Sickle cell crisis results from altered metabolism and dehydration
(b) Primary problems are due to tissue hypoxia and vascular occlusion
(c) Increased bilirubin levels lead to hypertension
(d) Clotting factors decrease with increased white blood cells
Answer:
(b) Primary problems are due to tissue hypoxia and vascular occlusion
Explanation:
Sickle cell disease is a hereditary anemia which mutates hemoglobin and distorts red blood cells to a sickle or crescent shape when oxygen levels are low. The oxygen-carrying capacity of red blood cells is decreased, leading to tissue hypoxia. Sickled cells clump together, leading to vascular occlusion.
Rationale:
(a) is incorrect because sickle cell crisis results from tissue hypoxia and vascular occlusion. (Dehydration should, however, be avoided in crisis because it can prolong or worsen the crisis.)
(c) is incorrect because bilirubin levels are not related to sickle cell crisis.
(d) is incorrect because clotting factors are not part of sickle cell crisis.
Question 5.
The nurse is interviewing the parents of a 3-year-old boy with Down syndrome. Which of the following goals of care does the nurse identify as appropriate for this child?
(a) Encourage self-care skills
(b) Teach the child something new each day
(c) Encourage lenient behavior limits
(d) Achieve age-appropriate social skills
Answer:
(a) Encourage self-care skills
Explanation:
Down syndrome is a genetic defect characterized by an extra chromosome, number 21. Common features include short stature, decreased muscle tone, large forehead, flattened facial features, low-set ears, a low nasal bridge, congenital heart defects, and intellectual disability. The IQ generally ranges from 20 to 70. The primary goal for Down syndrome is teaching independence and self-care as much as possible to promote optimal functioning.
Rationale:
(b) is incorrect because learning new things daily may not be possible for a child with Down syndrome.
(c) is incorrect because behavior standards and discipline should be consistent for a child with Down syndrome. Lenient behavior limits may lead to behavioral problems and inability to follow rules and learn to adapt to societal expectations.
(d) is incorrect because this is an unrealistic expectation: the child with Down syndrome may not be able to attain age-appropriate social skills.
Question 6.
The nurse is teaching the parents of a 2-year-old boy diagnosed with Duchenne’s muscular dystrophy about the disease and management. Which statement by the parents indicates the teaching was successful?
(a) “My son will probably not be able to walk by the time he is 9 years old.”
(b) “Muscle relaxants work for some children; I hope they help my son.”
(c) “When my son is a little older, surgery can improve his ability to walk.”
(d) “I must help my son be active as possible to prevent disease progression.”
Answer:
(a) “My son will probably not be able to walk by the time he is 9 years old.”
Explanation:
Muscular dystrophy is an X-linked recessive disorder transmitted by female carriers to affected sons 50 percent of the time. The disease is characterized by progressive muscle weakness, joint contractures, and lordosis/scoliosis. Children with this disease usually are unable to walk independently by the age of 9 years.
Rationale:
(b) is incorrect because muscle relaxants are not used to treat muscular dystrophy.
(c) is incorrect because there is no surgical treatment for muscular dystrophy. Treatment generally includes intensive physical therapy, active and passive range of motion exercises, and in best cases, long-leg braces to help with ambulation.
(d) is incorrect because no effective treatment has been found to delay the progression of muscular dystrophy. Muscular dystrophy is generally progressive and fatal.
Question 7.
A new mother has just been informed her newborn has Down syndrome. The nurse is preparing to assess the newborn at the beginning of the shift. Which characteristic does the nurse not associate with Down syndrome?
(a) Simian crease
(b) Brachycephaly
(c) Oily skin
(d) Hypotonicity
Answer:
(c) Oily skin
Explanation:
Down syndrome is a genetic defect that causes decreased muscle tone, large forehead, flattened facial features, congenital heart defects, and intellectual disability. Characteristics include Simian crease, brachycephaly, dry skin, and hypotonicity.
Rationale:
(a) is incorrect because Simian crease (also known as a single palmar crease) is associated with Down syndrome. Most people have three palmar creases, which develop while in utero. A single palmar crease is seen in people whose fetal development was interrupted, such as Down syndrome, Trisomy 13, and Fetal Alcohol Syndrome.
(b) is incorrect because brachycephaly is a shortened skull shape, associated with Down syndrome.
(d) is incorrect because hypotonicity (abnormally low muscle tone) is associated with Down syndrome.
Question 8.
The nurse in the pediatric unit is caring for a 6-year-old girl with cystic fibrosis. Which of the following is not part of the cystic fibrosis triad?
(a) Pancreatic enzyme deficiency
(b) Fever
(c) High concentration of sweat electrolytes
(d) COPD
Answer:
(b) Fever
Explanation:
Cystic fibrosis is a genetic disorder that affects exocrine production of mucous and sweat, causing dysfunction in the lungs and digestive system. The cystic fibrosis triad is pancreatic enzyme deficiency, high concentration of sweat electrolytes, and COPD. Fever is not part of the triad. However, fever in a cystic fibrosis patient may indication a lung infection, which increases the need for calories and protein.
Rationale:
(a) is incorrect because pancreatic enzyme deficiency is part of the cystic fibrosis triad. The patient often suffers from malabsorption of fat and fat- soluble vitamins and weight loss. Supplemental pancreatic enzymes are needed for lifelong replacement.
(c) is incorrect because high concentration of sweat electrolytes is part of the cystic fibrosis triad. Thickened secretions in the body include sweat and oral mucous.
(d) is incorrect because COPD is part of the cystic fibrosis triad and lung disease is common. Many cystic fibrosis patients require a lung transplant by the age of 25.
Question 9.
A child with cystic fibrosis is in the clinic with her mother reporting a cough and runny nose. The nurse teaches the child’s mother to do which of the following?
(a) Make sure the child has adequate nutritional intake
(b) Take the child’s temperature twice per day
(c) Offer plenty of orange juice
(d) Increase chest physiotherapy to four times daily
Answer:
(d) Increase chest physiotherapy to four times daily
Explanation:
Cystic fibrosis is a genetic disorder that affects production of mucous and sweat, causing dysfunction in the lungs and digestive system. The child is displaying early signs of an upper respiratory tract infection, which can quickly develop into pneumonia for a child with cystic fibrosis. Pulmonary secretions must be loosened and removed with percussion and postural drainage.
Rationale:
(a) is incorrect because eating well is important in general for a child with cystic fibrosis. The child generally needs a low-fat, high-protein, high-
calorie diet. However, with signs of a respiratory infection present, chest, physiotherapy is a bigger priority than dietary needs.
(b) is incorrect because frequent assessment of the child’s temperature is important but not as much as chest physiotherapy.
(c) is incorrect because a child with cystic fibrosis needs adequate hydration, and orange juice is not contraindicated, but chest physiotherapy is the greater priority. Foods to avoid with cystic fibrosis include peanut butter, milk, and other thick products or food items that can cause thickening of saliva.
Question 10.
The nurse in the pediatric medical-surgical unit is caring for a 10-year- old girl with cystic fibrosis. The child tells the nurse she feels like she isn’t getting enough air. Which of the following assessments is of greatest concern to the nurse?
(a) Sunken abdomen
(b) Distended jugular veins
(c) Edema in upper extremities
(d) Clubbing of fingers and toes
Answer:
(d) Clubbing of fingers and toes
Explanation:
Cystic fibrosis is a genetic disorder that affects production of mucous and sweat, causing dysfunction in the lungs and digestive system. Clubbing of fingers and toes indicates collateral circulation has been built to compensate for decreased oxygen levels.
Rationale:
(a) is incorrect because a sunken abdomen is a sign of poor nutritional intake but not as concerning as respiratory decompensation.
(b) is incorrect because distended jugular veins can be a sign of fluid volume overload or superior vena cava syndrome but are not related to the patient’s complaints that she is not getting enough air. The nurse’s greatest concern is respiratory decompensation and hypoxia.
(c) is incorrect because edema in upper extremities is unrelated to decreased oxygen levels.
Question 11.
The mother of a 6-year-old patient with hemophilia type A has received instructions from the clinic nurse. Which of the following statements indicates a need for further education?
(a) “I understand my child should avoid taking ibuprofen because this medication can affect clotting factors.”
(b) “We will encourage non-contact activities, such as swimming or golf.”
(c) “Aspirin is contraindicated because of my child’s age and diagnosis.”
(d) “I understand that the treatment for hemophilia does not increase my child’s risks for contracting diseases such as HIV and hepatitis C.”
Answer:
(d) “I understand that the treatment for hemophilia does not increase my child’s risks for contracting diseases such as HIV and hepatitis C.”
Explanation:
Hemophilia type A is a hereditary lack of coagulation factors which severely reduces the clotting ability of the blood. Treatment includes IV infusion of cryoprecipitate and factor VIII clotting factor, which are derived from blood products. Any time a patient receives blood products by transfusion, the risk for communicable diseases such as HIV and hepatitis C is increased.
Rationale:
(a) is incorrect because the statement indicates an understanding that ibuprofen affects clotting factors.
(b) is incorrect because it indicates an understanding that contact sports should be avoided due to the risk of easy bruising and bleeding with hemophilia.
(c) is incorrect because it indicates understanding that aspirin should be avoided in children and patients with hemophilia.
Question 12.
A 4-year-old boy is admitted to the pediatric oncology ward with a diagnosis of acute leukemia. Which of the following assessments is most concerning to the nurse?
(a) Abdominal pain and anorexia
(b) Fatigue and bruising
(c) Bleeding gums and pallor
(d) Weakness, weight loss, and mucosal ulcers
Answer:
(c) Bleeding gums and pallor
Explanation:
Acute leukemia is a malignant disease which causes increased numbers of abnormal or immature leukocytes to be produced from the bone marrow and blood-forming organs, suppressing normal blood cell production. Onset is generally quick and can progress to fatal termination within days to months. The child’s leukocyte count will be elevated and platelet count will be low, so monitoring for bleeding and pallor is most important.
Rationale:
(a) is incorrect because abdominal pain and anorexia are common and expected findings with acute leukemia.
(b) is incorrect because fatigue and bruising are common findings in a child with leukemia and not as alarming as bleeding and pallor.
(d) is incorrect because weakness, weight loss, and mucosal ulcers are not signs of a life-threatening complication with acute leukemia.
Question 13.
A 2-year-old boy has been diagnosed with cystic fibrosis. The mother asks the nurse what the major concern is now and what will happen in the future. What is the best response by the nurse?
(a) “There is a probability of lifelong complications.”
(b) “Cystic fibrosis results in nutritional concerns that can be dealt with.”
(c) “Thin, tenacious secretions from the lungs are a constant struggle with cystic fibrosis.”
(d) “You will have a team of experts and a support group you can attend.”
Answer:
(c) “Thin, tenacious secretions from the lungs are a constant struggle with cystic fibrosis.”
Explanation:
Cystic fibrosis is a genetic disorder that affects production of mucous and sweat, causing dysfunction in the lungs and digestive system. The tenacious secretions from the lungs are a struggle to deal with in cystic fibrosis, so respiratory threats are of major concern. This is the best of the answer choices because this nursing response addresses the mother’s question and gives information specific to the diagnosis.
Rationale:
(a) is incorrect because although it is a true statement, it is too vague. The nurse should give specific information related to the diagnosis and address the mother’s question.
(b) is incorrect because although it is a true statement, nutritional concerns are not the highest concern. The nurse must give truthful information related to the diagnosis and include teaching about the greatest concern, which is the child’s respiratory system.
(d) is incorrect because giving information about medical experts and support groups does not address the mother’s question.
Question 14.
An 8-year-old girl is diagnosed with non-Hodgkin’s lymphoma. The nurse knows the most urgent complication that must be evaluated at diagnosis and followed closely is which of the following?
(a) Elevated white blood cell count greater than 50,000/mm3
(b) Uric acid 5.0
(c) Mediastinal mass
(d) Complaints of left flank pain
Answer:
(c) Mediastinal mass
Explanation:
Non-Hodgkin’s lymphoma is cancer that begins in lymphocytes. A mediastinal mass should be ruled out in patients newly diagnosed with the cancer as this can progress to respiratory distress, tracheal compression, and superior vena cava syndrome, which is a medical emergency.
Rationale:
(a) is incorrect because white blood cell counts in non-Hodgkin’s lymphoma is usually decreased.
(b) is incorrect because the uric acid level is normal.
(d) is incorrect because complaints of left flank pain is important to assess but is not as urgent as a mediastinal mass.
Question 15.
The nurse on the pediatric oncology unit is administering vincristine sulfate to a 5-year-old boy with a brain stem glioma. Which of the following adverse reactions does the nurse monitor for?
(a) Typhlitis
(b) Diarrhea
(c) Constipation
(d) Appendicitis
Answer:
(c) Constipation
Explanation:
A brain stem glioma is either a benign or malignant collection of cells that form in brain tissue. Vincristine sulfate is vinka alkaloid antineoplastic medication which works by inhibiting cancerous cell division. It is used to treat Hodgkin’s disease and other lymphomas and cancers. Side effects nclude neuropathy, such as in the intestines, which can lead to constipation. It is also a priority to assess the IV site regularly because infiltration of this medication can be very toxic to the surrounding tissues.
Rationale:
(a) is incorrect because typhlitis (an infectious process that can arise during neutropenic episodes) is not common with vinka alkaloid medication administration.
(b) is incorrect because constipation is more likely to occur with vinka alkaloid medications.
(d) is incorrect because appendicitis is an infectious process that can arise during neutropenic episodes, not related to vinka alkaloid administration.
Question 16.
The nurse on the pediatric oncology unit is caring for a 10-year-old girl with a brain tumor. Which of the following observations would the nurse report immediately to the healthcare provider? (Select all that apply.)
(a) Urine output decrease from 40 ml/hr. to 25 ml/hr.
(b) Vomiting
(c) Visual changes
(d) Abdominal discomfort
(e) Diarrhea
(f) Headache
Answer:
(b) Vomiting
(c) Visual changes
(f) Headache
Explanation:
Vomiting, visual changes, and headache are all clinical manifestations of space occupying intracranial lesions or ventriculo-peritoneal shunt malfunction. These symptoms should be reported to the healthcare provider immediately.
Rationale:
(a) is incorrect because slightly decreased urine output does not require immediate reporting. This is still a normal urine output for a 10-year-old patient.
(d) is incorrect because abdominal discomfort requires further assessment but does not require immediate reporting to the healthcare provider.
(e) is incorrect because diarrhea may be a side effect of medications and does not require immediate reporting to the healthcare provider until the nurse assesses further.
Question 17.
The nurse is planning care for a 6-year-old male patient with hemophilia who requires factor VIII replacement twice weekly. Which of the following does the nurse include in the plan of care? (Select all that apply.)
(a) Avoid IV puncture due to risk of bleeding
(b) Maintain bedrest if acute bleeding occurs
(c) Take rectal temperature every 4 hours and report fever to healthcare provider
(d) Administer low-dose aspirin for pain instead of narcotics
(e) Avoid intramuscular injections
Answer:
(b) Maintain bedrest if acute bleeding occurs
(e) Avoid intramuscular injections
Explanation:
Hemophilia is a hereditaiy blood disorder in which the patent experiences lack of coagulation factors, which severely reduces the clotting ability of the blood. If the patient begins acutely bleeding, strict bedrest must be maintained. Intramuscular injections are not generally needed during treatment for hemophilia and should be avoided due to the risk for bleeding.
Rationale:
(a) is incorrect because IV access is necessary in order to administer factor VIII replacement. The nurse should monitor the IV site frequently for bleeding.
(c) is incorrect because rectal procedures and suppositories should be avoided in patients with hemophilia due to the risk for bleeding due to reduced ability of the blood to clot.
(d) is incorrect because salicylate medications, such as aspirin, increase the risk for bleeding and are inappropriate for a 6-year-old patient.
Question 18.
The nurse is providing teaching to the parents of a 7-year-old boy with phenylketonuria (PKU). Which of the statements by the parents indicates the teaching is understood? (Select all that apply.)
(a) “He will essentially be a vegetarian because he cannot have meat products.”
(b) “He must avoid all types of bread and pasta.”
(c) “No fresh flowers in his room.”
(d) “Diet ginger ale is acceptable in small quantities to help with nausea.”
(e) “Oher than the Guthrie test done at birth, no other routine blood testing will be necessary.”
(f) “He will have to learn to keep a food diary.”
Answer:
(a) “He will essentially be a vegetarian because he cannot have meat products.”
(f) “He will have to learn to keep a food diary.”
Explanation:
Phenylketonuria (PKU) is an inborn error of phenylalanine metabolism due to deficiency of a specific liver enzyme. Toxic metabolites can build up in the blood, leading to brain cell death and subsequent intellectual delay, seizures, and mental disorders. Foods that must be avoided include meat, eggs, and dairy products. A food diary must be kept in order to monitor the amount of phenylalanine the patient consumes daily. Food exchange lists (similar to those for patients with diabetes) can help the patient with swapping foods, depending on different choices made throughout the day.
Rationale:
(b) is incorrect because specially made low-protein breads and pastas are available for PKU patients, so they can still consume these foods in controlled quantities.
(c) is incorrect because PKU patients are not at specific risk for infection while hospitalized, and thus, fresh flowers are acceptable in the room.
(d) is incorrect because aspartame, used to sweeten diet soda, contains large amounts of phenylalanine and can be harmful. If the child is going to drink sweetened beverages, those sweetened with sugar are safer than diet options.
(e) is incorrect because routine bloodwork may be necessary to monitor phenylalanine levels in the blood.
Question 19.
The new nurse in the pediatric unit is caring for a male 4-year-old child with Duchenne Muscular Dystrophy (DMD). Which of the following statements is appropriate for the nurse to make when educating the child’s parents? (Select all that apply.)
(a) “This disorder may have resulted from lack of oxygen at birth.”
(b) “Due to recent medical research, a cure has been found for DMD.”
(c) “Although this disorder is much more common in females, the treatment will be very similar for your son.”
(d) “Muscle weakness generally worsens as age advances, so the home must be prepared for safety in case of falls.”
(e) “Your son may need some additional help in the classroom, but he may be able to attend school with other kids his age.”
Answer:
(d) “Muscle weakness generally worsens as age advances, so the home must be prepared for safety in case of falls.”
(e) “Your son may need some additional help in the classroom, but he may be able to attend school with other kids his age.”
Explanation:
Duchenne muscular dystrophy is an X-linked recessive disorder transmitted through female carriers to affected sons 50 percent of the time. Many DMD patients live into their twenties. Common signs and symptoms of muscular dystrophy include frequent falls, waddling gait, large calf muscles, decreased ability to ambulate as age advances, and muscle stiffness. DMD children often can be incorporated into a regular classroom with some physical assistance with tasks such as opening doors and ambulating throughout the classroom.
Rationale:
(a) is incorrect because DMD is not caused by oxygen deprivation at birth (cerebral palsy).
(b) is incorrect because no cure has been found for DMD and it is known to be a fatal disorder.
(c) is incorrect because DMD affects boys much more commonly than girls.
Question 20.
The nursing student in the family clinic is learning about Tetralogy of Fallot (TOF). Which of the following is true about TOF? (Select all that apply.)
(a) Surgery rarely can correct the mixed blood flow during infancy
(b) Hypercyanotic episodes indicate improvement in an infant with TOF
(c) Adults who were treated for TOF as a child will need to be followed by a cardiologist
(d) MRI may be needed shortly after birth
(e) Prenatal ultrasound rarely detects fetal cardiac abnormalities
Answer:
(c) Adults who were treated for TOF as a child will need to be followed by a cardiologist
(d) MRI may be needed shortly after birth
Explanation:
TOF is a congenital heart defect usually found at or before birth. Abnormalities prevent deoxygenated blood from reaching the lungs where it can be properly oxygenated for return to the left side of the heart. Lifelong follow-up with a cardiologist is necessary for TOF patents as additional surgeries may be necessary because complications from early heart disease can arise in adulthood. Testing after birth to confirm TOF (and determine the extent of the abnormalities) include chest X-ray, MRI, electrocardiogram, and in rare cases, cardiac catheterization.
Rationale:
(b) is incorrect because hypercyanotic episodes (“tet spells”) indicate worsening of TOF. These may occur after activity such as bathing or feeding, in which the infant experiences a further decrease in blood flow to the lungs and becoming bluer in color.
(e) is incorrect because prenatal testing can often indicate whether the fetus has cardiac abnormalities. This can give the healthcare provider advanced warning of the need for additional cardiac support for the infant at birth.
Question 21.
The nurse in the pediatric unit is caring for a 6-year-old girl with phenylketonuria (PKU). The nurse includes which of the following statements when talking with the child’s parents? (Select all that apply.)
(a) “Your child may be at increased risk for eczema.”
(b) “It is important to call the healthcare provider if you observe any signs of seizure activity.”
(c) “PKU increases the risk for developing Attention Deficit Disorder (ADD).”
(d) “You may notice more impulsive behavior in your child due to the effects of PKU on the brain.”
(e) “Motor problems may occur. Additional therapy is available to help your child develop fine and gross motor skills.”
Answer:
(a) “Your child may be at increased risk for eczema.”
(b) “It is important to call the healthcare provider if you observe any signs of seizure activity.”
(d) “You may notice more impulsive behavior in your child due to the effects of PKU on the brain.”
(e) “Motor problems may occur. Additional therapy is available to help your child develop fine and gross motor skills.”
Explanation:
Phenylketonuria (PKU) is a recessive gene disorder that causes the liver to not produce enzymes to break down phenylalanine (amino acid), which then accumulates and is toxic to the brain. Children with PKU are at risk for developing eczema, seizures, impulsiveness, and motor problems.
Rationale:
(c) is incorrect because ADD is not a risk related to PKU.
Question 22.
The nurse in the pediatric emergency room is caring for a 9-year-old girl in sickle cell crisis. Her hemoglobin is 10 g/dL, and she is complaining of severe pain in her leg joints. Which of the following does the nurse anticipate implementing? (Select all that apply.)
(a) Folic acid supplements
(b) High-iron foods
(c) Ice packs to leg joints
(d) V fluids
(e) IV morphine
Answer:
(a) Folic acid supplements
(d) V fluids
(e) IV morphine
Explanation:
Sickle cell disease is a hereditary anemia which mutates hemoglobin and distorts red blood cells to a sickle or crescent shape when oxygen levels are low. In order to manage the sickle cell crisis, the nurse anticipates folic acid supplements for erythropoiesis, IV fluids to decrease blood viscosity, and IV morphine for pain control.
Rationale:
(b) is incorrect because high-iron foods are not necessary for sickle cell crisis.
(c) is incorrect because ice packs would cause further sickling of red blood cells.
Question 23.
The nurse is providing dietary teaching to the parents of a 6-year-old recently diagnosed with phenylketonuria (PKU). Which of the following dietary choices indicate the teaching has been successful? (Select all that apply.)
(a) Bananas with peanut butter
(b) Green beans with olive oil and salt
(c) Chicken with potatoes
(d) Turkey and steamed carrots
(e) Sugar-based lollipop
Answer:
(b) Green beans with olive oil and salt
(e) Sugar-based lollipop
Explanation:
Phenylketonuria (PKU) is a recessive gene disorder that causes the liver to not produce enzymes to break down phenylalanine (amino acid), which then accumulates and is toxic to the brain. Dietary choices for children with PKU include fruits, vegetables, and low-protein natural
foods. Sugar-based candies that do not contain protein, dairy, or aspartame (artificial sweetener) are acceptable treats.
Rationale:
(a) is incorrect because, although a banana is a good choice for a PKU patient, the peanut butter is high in protein.
(c) is incorrect because chicken is high in protein.
(d) is incorrect because turkey is high in protein.
Question 24.
The nurse in the pediatric intensive care unit (PICU) is caring for a 7- year-old girl after a craniotomy surgery for removal of a brain tumor. When assessing the child, for which of the following should the nurse notify the healthcare provider? (Select all that apply.)
(a) Absence of pronator drift
(b) The patient frequently requests water to drink
(c) Polyuria
(d) Pupils react slowly to light accommodation
(e) Blood pressure changes from 95/65 to 118/58
Answer:
(c) Polyuria
(d) Pupils react slowly to light accommodation
(e) Blood pressure changes from 95/65 to 118/58
Explanation:
Polyuria can be a manifestation of diabetes insipidus, a complication after craniotomy. Pupils should respond quickly light; sluggish pupil reaction can be an early sign of increasing intracranial pressure (ICP). Increased pulse pressure is a sign of increasing ICP and should be reported to the healthcare provider. (Note: Pulse pressure is the difference between the systolic and diastolic pressure and is normally 30-40 mm/Hg.)
Rationale:
(a) is incorrect because absence of pronator drift is a good finding post-craniotomy. Pronator drift can be an indication of increasing intracranial pressure.
(b) is incorrect because thirst is common post-operatively and is not a sign of a complication.
Question 25.
A 9-year-old boy is hospitalized for leukemia and receiving combination chemotherapy. Lab results indicate neutropenia, and the nurse is preparing to implement protective isolation. Which of the following interventions does the nurse initiate? (Select all that apply.) ;
(a) Restrict all visitors
(b) Place on a low-bacteria diet
(c) Delegate the nursing assistant to change dressings using sterile technique
(d) Encourage fresh fruits and vegetables
(e) Meticulous handwashing before care
(f) Fresh-cut flowers allowed if vase water is changed daily
Answer:
(b) Place on a low-bacteria diet
(e) Meticulous handwashing before care
Explanation:
Leukemia is a malignant disease which causes increased numbers of abnormal or immature leukocytes to be produced from the bone marrow and blood-forming organs, suppressing normal blood cell production. Vegetables and fruits can harbor microorganisms which can lead to infections in the immunocompromised child. All fruits and vegetables should be peeled or cooked. Dressing changes should be performed using sterile technique. Meticulous handwashing is priority for the neutropenic child.
Rationale:
(a) is incorrect because not all visitors should be restricted, only those who are ill.
(c) is incorrect. Although a sterile technique is needed for all dressing changes for a patient on neutropenic precautions, the nurse cannot delegate sterile procedures to the nursing assistant.
(d) is incorrect because fresh fruits and vegetables can harbor microorganisms, increasing the risk for infection.
(f) is incorrect because standing water in a vase, even when changed daily can harbor microorganisms.