C HAPTER 27: T HE C HILD WITH A C ONDITION
OF THE B LOOD , B LOOD -F ORMING O RGANS , OR
L YMPHATIC S YSTEM
Introduction to Maternity and Pediatric Nursin g, 8th Edition ; Leifer
MULTIPLE CHOICE
1. A child has just been diagnosed with acute l ymphoblastic leukemia. What
is the result of an overproduction of immature white blood cells in the
bone marrow?
a. Decreased T -cell production
b. Decreased hemoglobin
c. Increased blood clotting
d. Increased susceptibilit y to infection
ANS: D
An overproduction of immature white blood cells increases the childs
susceptibilit y to infection.
DIF: Cognitive Level: Comprehension REF: Page 648
TOP: Leukemia KEY: Nursing Process Step: Data
Collection MSC: NC LEX: Physiological Integrit y:
Physiological Adaptation
,2. 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 immediatel y.
c. Give diphenhydramine (Benadryl).
d. Clamp off blood and keep line open with normal saline.
ANS: D
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.
DIF: Cognitive Level: Application REF: Page 650 TOP:
Blood Transfusion KEY: Nursing Process Step:
Implementation MSC: NC LEX: Physiological Integrit y
3. What would the nurse include in a teaching plan about mouth care of a
child receiving chemotherapy?
a. Use commercial mouthwash.
b. Clean teeth with a soft toothbrush.
c. Avoid use of a Water -Pik.
d. Inspect the mouth weekl y for ulcerations.
ANS: B
A soft toothbrush reduces capillary damage and mucous membrane
breakdown and prevents bleeding and infection. Commer cial
mouthwashes may kill oral flora that combat infection. Water -Pik is
useful for toughening gums.
, DIF: Cognitive Level: Application REF: Page 650 TOP:
Leukemia KEY: Nursing Process Step: Planning MSC:
NCLEX: Physiological Integrit y: Basic Care and Comfort
4. A 6-year-old with leukemia asks, Who will take care of me in heaven?
What is the best response by the nurse?
a. Who do you think will take care of you?
b. Your grandparents and God will take care of you.
c. Your mom will know more about that than I do.
d. Why are you asking me that?
ANS: A
This response gives the child an opportunit y to verbalize his or her
feelings and concerns, whereas closed responses shut off
communication. The asking of a why question is not therapeutic as it
calls for justification.
DIF: Cognitive Level: Application REF: Page 650 TOP:
Leukemia KEY: Nursing Process Step: Implementation
MSC: NC LEX: Psychosocial Integrit y: Coping and
Adaptation
5. The nurse is dealing with a preschool -age child with a life -threatening
illness. What sh ould the nurse remember the childs concept of death is at
this age?
a. That it is final
b. Onl y a fear of separation from her parents
c. That a person becomes alive again soon after death
OF THE B LOOD , B LOOD -F ORMING O RGANS , OR
L YMPHATIC S YSTEM
Introduction to Maternity and Pediatric Nursin g, 8th Edition ; Leifer
MULTIPLE CHOICE
1. A child has just been diagnosed with acute l ymphoblastic leukemia. What
is the result of an overproduction of immature white blood cells in the
bone marrow?
a. Decreased T -cell production
b. Decreased hemoglobin
c. Increased blood clotting
d. Increased susceptibilit y to infection
ANS: D
An overproduction of immature white blood cells increases the childs
susceptibilit y to infection.
DIF: Cognitive Level: Comprehension REF: Page 648
TOP: Leukemia KEY: Nursing Process Step: Data
Collection MSC: NC LEX: Physiological Integrit y:
Physiological Adaptation
,2. 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 immediatel y.
c. Give diphenhydramine (Benadryl).
d. Clamp off blood and keep line open with normal saline.
ANS: D
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.
DIF: Cognitive Level: Application REF: Page 650 TOP:
Blood Transfusion KEY: Nursing Process Step:
Implementation MSC: NC LEX: Physiological Integrit y
3. What would the nurse include in a teaching plan about mouth care of a
child receiving chemotherapy?
a. Use commercial mouthwash.
b. Clean teeth with a soft toothbrush.
c. Avoid use of a Water -Pik.
d. Inspect the mouth weekl y for ulcerations.
ANS: B
A soft toothbrush reduces capillary damage and mucous membrane
breakdown and prevents bleeding and infection. Commer cial
mouthwashes may kill oral flora that combat infection. Water -Pik is
useful for toughening gums.
, DIF: Cognitive Level: Application REF: Page 650 TOP:
Leukemia KEY: Nursing Process Step: Planning MSC:
NCLEX: Physiological Integrit y: Basic Care and Comfort
4. A 6-year-old with leukemia asks, Who will take care of me in heaven?
What is the best response by the nurse?
a. Who do you think will take care of you?
b. Your grandparents and God will take care of you.
c. Your mom will know more about that than I do.
d. Why are you asking me that?
ANS: A
This response gives the child an opportunit y to verbalize his or her
feelings and concerns, whereas closed responses shut off
communication. The asking of a why question is not therapeutic as it
calls for justification.
DIF: Cognitive Level: Application REF: Page 650 TOP:
Leukemia KEY: Nursing Process Step: Implementation
MSC: NC LEX: Psychosocial Integrit y: Coping and
Adaptation
5. The nurse is dealing with a preschool -age child with a life -threatening
illness. What sh ould the nurse remember the childs concept of death is at
this age?
a. That it is final
b. Onl y a fear of separation from her parents
c. That a person becomes alive again soon after death
