NUR 2356 FINAL EXAM 2 LATEST VERSIONS 2024 MULTIDIMENSIONAL CARE 1 FINAL/ MDC 1 FINAL EXAM, Exams of Nursing

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EXAM QUESTIONS AND CORRECT ANSWER S|RASMUSSEN COLLEGE/GET IT 100% ACCURATE !! Red blood cell production is stimulated by:

1. Tachycardia
2. Tachypnea
3. Renin angiotensin
4. Hypoxia - correct answer Hypoxia 4 Main components of blood composition - correct answer RBC, WBC, platelets, plasma What is the composition of plasma - correct answer 90% H2O 10% solutes - glucose, protein, albumin, hormones, etc Where is bone marrow aspiration in infants? - correct answer Tibia Where is bone marrow aspiration in toddlers and preschoolers? - correct answer femur and tibia Where is bone marrow aspiration in children over 5? - correct answer pelvis (iliac crest) Where is bone marrow production in young adults/adults? - correct answer ribs, sternum, vertebra, pelvis, skull, clavicle, scapula what is anemia - correct answer a condition in which levels of red blood cells and hemoglobin are lower than normal 4 types of anemia - correct answer Iron deficiency lead poisoning sickle cell B-thalassemia Define iron deficiency anemia - correct answer reduction in the iron stores of the body causing an inadequate production of hemoglobin What is iron needed for? - correct answer to make hgb signs and symptoms of iron deficiency anemia - correct answer pallor tachycardia tachypnea lethargy

EXAM QUESTIONS AND CORRECT ANSWER S|RASMUSSEN COLLEGE/GET IT 100% ACCURATE !! fatigue irritability Why are neonates at risk for iron deficiency anemia? - correct answer - lack the maternal iron stores

• Full term infants have maternal iron stores until approximately 6 months of age
• Havent had the time in utero to store up the needed iron supply (preterm) How can you treat a neonate with iron deficiency anemia? - correct answer Iron fortified formula What are risk factors for iron deficiency anemia in infants and children? - correct answer 1.inadequate iron intake 2.Malabsorption of iron in GI tract 3.Chronic blood loss Food with good sources of iron - correct answer red meat, egg yolk, leafy greens, dried fruits, fortified cereals/formulas, beef, chicken, fish, beans, nuts, seeds, peanut butter, eggs, prunes, whole grain bread How is iron deficiency anemia diagnosed? - correct answer Serum lab evaluation:
• Red blood cell count = microcytic (small) and hypo chronic (pale in color)
• low hemoglobin
• low hematocrit
• low reticulocyte count
• low serum iron concentration
• high total iron binding capacity What is the goal of treatment for iron deficiency anemia - correct answer treat medical problem causing malabsorption or blood loss/ identify cause What is the treatment method for iron deficiency anemia? - correct answer Increase iron take ~ Dietary sources ~Medication supplement (ferrosol or ferrous sulfate) What should nurses and parents know about administering iron to children? - correct answer - Administer to back of mouth because it stains teeth, can cause constipation, and black/green stool

EXAM QUESTIONS AND CORRECT ANSWER S|RASMUSSEN COLLEGE/GET IT 100% ACCURATE !!

• Give with orange juice or citric acid to help with absorption
• Do not give with milk or antacids
• Give on empty stomach unless GI distress Lead Poisoning Risks - correct answer - Children under the age of 6
• Children living at or below the poverty line who live in older (prior to 1978) housing
• Children adopted from other countries where there are less strict environmental regulations Environmental causes of lead poisoning - correct answer - Lead based paint
• Plumbing from lead pipes
• soil Dietary factors of lead poisoning - correct answer - iron deficiency
• calcium deficiency Patient-child interactions - correct answer - Job or hobby exposure
• home remedies or cultural practices How does lead poisoning cause anemia - correct answer lead can replace iron on Hgb causing O2 to not be delivered causing anemia Clinical manifestation of lead poisoning - correct answer - Asymptomatic
• Signs of anemia
• Growth and developmental lags
• Behavioral changes
• Neurologic changes
• Gastrointestinal changes can someone be asymptomatic if they have lead poisoning - correct answer yes signs of anemia (lead poisoning) - correct answer pallor, fatigue, weakness, shortness of breath, headache, tachycardia - because lead replaces iron in Hgb causing anemia Growth and developmental lags in lead poisoning - correct answer learning difficulties Neurologic signs and symptoms of lead poisoning - correct answer - Headache, irritability, difficulty concentrating, loss of motor skills, paralysis, tremors

EXAM QUESTIONS AND CORRECT ANSWER S|RASMUSSEN COLLEGE/GET IT 100% ACCURATE !! High levels: encephalopathy, seizures, and brain damage Gastrointestinal signs and symptoms of lead poisoning - correct answer abdominal pain, failure to gain weight, weight loss, vomiting, constipation Lead poisoning diagnostics - correct answer Blood lead level (BBL) test

• 5mcg/dL = lead exposure
• 45 mcg/dL = medical treatment required with chelation therapy

• 70= mcg/dL = severe lead toxicity Therapeutic management of lead poisoning - correct answer - Decontamination

• Chelation
• Supportive therapy
• Deterrence and prevention How do you decontaminate a person with lead poisoning? - correct answer Xray of GI tract to see of lead is there. if it is, they flush it out to stop absorption when to use Chelation therapy for lead poisoning - correct answer - 45 - 69 mcg/dL outpatient therapy with oral succorer and parenteral disodium calcium edetate

• 70 Hospitalization with dimercaprol and disodium calcium EDTA

• Monitor urinary output (possibly on 24 hour urine collection) What do patients who have lead poisoning need in their diet? - correct answer Adequate calcium, iron, and vitamin C Chelation drugs - correct answer 1.Edetate calcium disodium (CaNA2EDTA) 2.Succimer (Chemet) 3.Dimercaprol (BAL in Oil) Information on Chelation drug Edetate calcium disodium (CaNA2EDTA) - correct answer - Given IM or IV for 5 days
• Increase lead concentrations in CNS resulting in encephalopathy in its with BLL >70 mcg/dL, used in combination with dimercaprol Information on chelation drug Succimer (Chemet) - correct answer - Given po every 8hrs x 5 days, then every 12 hours x 2 wks
• Capsules contain small beads that can be mixed with food. Cannot be given through a syringe

EXAM QUESTIONS AND CORRECT ANSWER S|RASMUSSEN COLLEGE/GET IT 100% ACCURATE !! Information on chelation drug Dimercaprol (BAL in Oil) - correct answer - Drug of choice in severe lead toxicity cases (BLL >70)

• IM every 4 hours with CaNA2EDTA started with dose 2
• Do not give with peanut allergy because it is made with peanut oil
• No iron supplements if receiving Dimercaprol because it can form toxic complex if mixed with iron Nursing interventions with lead poisoning - correct answer Monitoring parameters
• Blood lead levels
• Monitor fluid intake and urine output
• Seizure precautions Dietary Considerations
• High iron
• Limit milk intake to 24 hours
• Adequate calcium and vitamin c Prevention - screening
• Nutrition education: iron rich foods, calcium rich foods, vitamin c rich foods Define sickle cell disease - correct answer Sickle cell disease is a group of disorders that affects hemoglobin. People with this disorder have atypical hemoglobin molecules called hemoglobin S, which can distort red blood cells into a sickle or crescent shape What is normal adult hemoglobin? - correct answer Hemoglobin A What is the primary hemoglobin produced by the fetus? - correct answer Hemoglobin F When does Hemoglobin F transfer into Hemoglobin A? - correct answer Around 1-2 years old Hemoglobin F does what to sickling of red blood cells? - correct answer inhibits the sickling Define hemoglobinopathy - correct answer A hemoglobin abnormality is a variant form of hemoglobin that is often inherited and may cause a blood disorder (abnormal production or structure of hemoglobin molecules) What is the primary hemoglobin in patients with sickle cell anemia? - correct answer Hemoglobin S

EXAM QUESTIONS AND CORRECT ANSWER S|RASMUSSEN COLLEGE/GET IT 100% ACCURATE !! What causes increased production of Hemoglobin F? And why? - correct answer Hydroxurea because it causes immunosuppression and it acts like a chemo drug Define sickle cell trait - correct answer describes a condition in which the person has one abnormal allele of the hemoglobin gene (is heterozygous), but does not display the severe symptoms of sickle cell disease that occur in a person who has two copies of that allele (is homozygous) (They carry only one gene of sickle cell but don't actually have the disease, they are just a carrier of it.) What happens with the hemoglobin in sickle cell anemia? - correct answer Sickle cell abnormal Hemoglobin S (HbSS) replaces all or part of the normal adult hemoglobin (HbAA) What is used to diagnose sickle cell anemia? - correct answer Hemoglobin electrophoresis What happens when RBCs change from round to sickle shaped? - correct answer Results in chronic hemolytic anemia and ischemic tissue injury What are sickle cell triggers? - correct answer extreme temperatures, exercise, dehydration, infection, extreme stress What are 2 issues of sickle cell anemia and define them? - correct answer Obstruction - caused by sickling RBCs causing micro-occlusion or vascular occlusion blocking blood flow (hypoxia, ischemia, infarction [cell death]) Destruction - sickle cells have a short life span and body has to destroy them and it is a lot of stress on the spleen Ophthalmic complications of sickle cell - correct answer vitreous hemorrhage, retinal detachment, and blindness Vaso-occlusive crisis of sickle cell Chest syndrome hand and foot syndrome Cerebrovascular accident - correct answer chest syndrome includes chest pain, fever, and cough and can be precipitated by or result from pneumonia

EXAM QUESTIONS AND CORRECT ANSWER S|RASMUSSEN COLLEGE/GET IT 100% ACCURATE !! hand and foot syndrome (dactylics may be the first symptom of vaso-occlusion cerebrovascular accident is caused by vaso-occlusion of vessels in the brain, resulting in cerebral infarction Abdominal and GU complications of sickle cell - correct answer abdominal pain and genitourinary disfunction (dilute urine) What is Splenic sequestration crisis of sickle cell - correct answer Caused by pooled blood that enlarges the spleen significantly 3 functions of the spleen - correct answer 1.filters blood and removes old and damaged RBCs 2.controls level of blood cells (white, red, and platelets) 3.contains WBCs Define functional asplenia - correct answer reduction in splenic function Define the process in developing functional asplenia - correct answer initially the spleen becomes enlarged from congestion and engorgement with sickled cells and repeated insult to the spleen leads to infarction - the functional cells are replaced by fibrotic tissue. what does functional asplenia cause patients to become - correct answer immunocompromised Infection prevention in sickle cell patients - correct answer - Penicillin prophylaxis = oral penicillin until 5 years old

• Immunization schedule modification ~ Routine PVC-13 given. two doses of 23-valent pneumococcal at age 2 and 5 ~ Meningococcal vaccine 4 dose series: 2, 4, 6, 12 months ~Hemophilus influenzae type B (Hib) vaccine at age 2 years (additional dose) ~Annual flu vaccine 3 major crises seen in children with sickle cell anemia - correct answer aplastic crisis splenic sequestration vast-occlusive crisis (VOC) Define aplastic crisis - correct answer Transient suppression of RBC production in the bone marrow with hemolysis of all blood cells

EXAM QUESTIONS AND CORRECT ANSWER S|RASMUSSEN COLLEGE/GET IT 100% ACCURATE !! (temporary shutdown of red blood cells) What can cause aplastic crisis? - correct answer - Infection = viral, especially human parvovirus B19 (Fifths disease)

• Depletion of folic acid What are the clinical manifestations of aplastic crisis? - correct answer - Profound anemia, pallor
• Neutropenia - fever; Risk for infection
• Thrombocytopenia - risk for bleeding anywhere What is the treatment for aplastic anemia? - correct answer Packed RBC transfusion Define splenic sequestration - correct answer Pooled blood in spleen is not available to the general circulation and it is life threatening because it can lead to splenic rupture What are the clinical manifestations of splenic sequestration - correct answer - Profound anemia
• Hypovolemia
• Shock Therapeutic management of splenic sequestration - correct answer - Blood transfusion
• Splenectomy Define vaso-occlusive crisis - correct answer Stasis of blood with clumping of cells in the microcirculation causing ischemia (insufficient supply of blood) and infarction (an area of tissue necrosis) What can cause vaso-occlusive crisis - correct answer - Dehydration
• extreme temperatures
• infection
• localized hypoxemia
• stress Therapeutic management of vaso-occlusive crisis - correct answer - pain control
• hydration

EXAM QUESTIONS AND CORRECT ANSWER S|RASMUSSEN COLLEGE/GET IT 100% ACCURATE !!

• rest
• increase tissue perfusion
• treat infection Pharmacological and non pharmacological pain control measures for sickle cell anemia - correct answer - Opiates (PCA pump)
• NSAIDS
• Around the clock
• Acetaminophen
• Warm compresses
• Guided imagery
• Distraction
• Relaxation Why is adequate hydration so important in children with sickle cell anemia - correct answer Dehydration can cause sickling and clumping of cells, keeps the kidneys working well, and reduced incidence of stroke What teaching can you do related to hydration? - correct answer - how much fluid they should get and then more
• Drink on commercial breaks
• drinking games Define acute chest syndrome and what is it most commonly caused by - correct answer A life threatening complication caused by vascular occlusion in the lungs (Sickling of blood in lungs) caused by bacterial pneumonia - esp streptococcus pneumoniae A patient with sickle cell anemia presents to the hospital with chest pain, fever, tachypnea, coughing, and/or wheezing. What syndrome would you expect them to be in? - correct answer Acute chest syndrome What diagnostic tests would be ordered to determine acute chest syndrome - correct answer - Chest x-ray

EXAM QUESTIONS AND CORRECT ANSWER S|RASMUSSEN COLLEGE/GET IT 100% ACCURATE !!

• blood culture and sensitivity (from bacterial pneumonia) How would a nurse treat a patient with acute chest syndrome - correct answer - Aggresive antibiotic therapy (from bacterial pneumonia)
• supplemental O2 PRN
• pain management What surgical procedure may be required for a patient with sickle cell who presents with chronic massive splenomegaly, severe anemia, neutropenia, and thrombocytopenia? - correct answer Splenectomy Why are blood transfusions (Packed RBCs or Exchange transfusion) used as a treatment for sickle cell anemia? - correct answer - Improves tissue oxygenation
• Corrects anemia
• Temporarily reduces the % of HbS What is Beta-Thalassemia? - correct answer An inherited disorder characterized by less hemoglobin and fewer red blood cells in the body than normal. What is beta thalassemia minor (AKA: thalassemia trait) - correct answer - Produces hypo- chromic (pale) and microcytic (small) RBCs
• Hgb levels 2-3g/dL below normal levels What is beta thalassemia intermediate (AKA: thalassemia intermedia) manifested as? - correct answer Manifested as splenomegaly and severe anemia What is beta thalassemia major (AKA: Thalassemia major)? And what is it also known as? - correct answer Severe complications and requires transfusions to sustain life (Hgb falls below 5g/dL) AKA Cooley's Anemia A patient presents to the hospital with findings of anemia, characteristic facies (Distinctive facial features), osteoporosis, epistaxis (nose bleed), and damage to many organs of the body. What condition could they have? - correct answer Beta-Thalassemia What are the 3 consequences and their definitions of the hemolysis of RBCs? - correct answer 1.anemia 2.hemosiderosis - excess iron stores in various tissues of the body but with no tissue damage 3.hemochromatosis - excess iron storage with cellular damage

EXAM QUESTIONS AND CORRECT ANSWER S|RASMUSSEN COLLEGE/GET IT 100% ACCURATE !! What are the benefits of hypertransfusion therapy for beta-thalassemia - correct answer - suppresses extra medullary erythropoiesis

• minimizes facial alterations
• decreses the risk of osteoporosis
• reduces the possibility of splenectomy
• lessens cardiac dilation (basically the opposite of the clinical manifestations) What are 4 other treatment measures (besides hyper transfusion) for beta-thalassemia - correct answer 1. iron chelation therapy with Exjade (deferasirox) and/or Desferal (deferoxamine)

2. Oral supplementation of vitamin C and avoidance of iron rich foods
3. Splenectomy
4. Bone marrow or stem cell transplants Define hemophilia and what are the 2 types - correct answer A group of hereditary bleeding disorders that result from a deficiency in specific clotting factors
5. Hemophilia A or "Classic hemophilia" = missing Factor VIII (antihemophilic factor-AHF)
6. Hemophilia B or "Christmas disease" = missing Factor IX (plasma thromboplastin component

• PTC) How is hemophilia diagnosed? - correct answer - History of bleeding
• X-linked inheritance
• Lab findings What lab tests would be ordered on a patient who is suspected to have hemophilia? - correct answer Clotting studies - PT, PTT, aPTT, INR Coagulating factor concentrations

EXAM QUESTIONS AND CORRECT ANSWER S|RASMUSSEN COLLEGE/GET IT 100% ACCURATE !! A patient with hemophilia is placed on what precautions and what are the goals when they are hospitalized and at home? - correct answer Bleeding precautions/ prevention of bleeding Hospitalized

• No rectal temps
• No continuous BP monitoring
• No IM if possible
• Stool softeners, if risk for constipation Home
• Avoid injury
• Medication administration
• School education What are the clinical manifestations of hemophilia - correct answer - Prolonged bleeding, bruising, and epistaxis
• Internal bleeding
• Hemarthrosis - bleeding into the joint cavity ~ early signs = feeling of stiffness, tingling, or ache followed by decrease in the ability to move the joint A nurse is suspecting their patient with hemophilia is bleeding internally based on the assessment findings from GI, GU, and CNS. What assessment findings lead them to this suspect and what nursing interventions might be performed? - correct answer GI: abdominal pain, frank blood in stool or dark black stool, vomiting blood ~ NSG: guaiac stool GU: abdominal or lower back pain, blood in urine ~NSG: perform urine dipstick for hematuria and encourage PO fluids CNS: headache, change in LOC, weakness, gait change

EXAM QUESTIONS AND CORRECT ANSWER S|RASMUSSEN COLLEGE/GET IT 100% ACCURATE !! ~NSG: neuro assessments Therapeutic management of a bleeding episode in a patient with hemophilia - correct answer - Administer medications ~factor for moderate to severe hemophiliacs (prophylactic treatment to prevent bleeding episodes with sever hemophilia) ~ Desmopressin Acetate (DDAVP) for mild to moderate Hemophilia A patients

• Administration of blood products (packed RBC or FFP)
• Nursing considerations ~Double check the factor or blood product transfusion with another RN hemarthrosis
• For hemarthrosis (bleeding in joint): immobilize and elevate (RICE) Define Immune thrombocytopenic purpura (ITP) - correct answer A bleeding disorder characterized by increased destruction of platelets in spleen platelet destruction due to an antiplatelet antibody that destroys platelets making this an autoimmune disorder A patient presents to the hospital with excessive bruising, miniature petechiae, large areas of asymmetrical ecchymosis, epistaxis, and marked thrombocytopenia but normal WBC, Hgb, and Hct. What condition may this patient have? - correct answer Immune thrombocytopenic purpura (ITP) True or false: Children with Immune thrombocytopenic purpura (ITP) require immediate medical treatment. - correct answer FALSE!!!! many children only require observation and reevaluation of labs. No medical interventions are required

EXAM QUESTIONS AND CORRECT ANSWER S|RASMUSSEN COLLEGE/GET IT 100% ACCURATE !! A nurse is assessing if the patient and family understood her instructions for their child with Immune thrombocytopenic purpura (ITP). Which statement by the family needs further teaching? "We can give our child aspirin, NSAIDS, or antihistamines if he has any pain." "We must prevent any serious traumas that may involve our child." "We will watch for any signs of bleeding in our child." - correct answer DO NOT GIVE THIS PATIENT ASPIRIN, NSAIDS, OR ANTIHISTAMINES! All other options are correct A nurse is reviewing the orders in the chart for her patient with Immune thrombocytopenic purpura (ITP). Would she follow the orders or question what was put in?

• Steroid therapy for 2-4 weeks
• IVIGs given once a day foe 3-5 days
• Possible platelet transfusion or splenomegaly if no improvement - correct answer All these orders are accurate A nurse is educating a group of students on Immune thrombocytopenic purpura (ITP). They responded with the following education topics to teach the child and family. Which options are correct?
• Pad the crib or bed and furniture
• Use a soft bristled toothbrush
• They can play in any sport they desire as long as they have the correct padding equipment
• Follow up appointments for weekly platelet counts
• Signs and symptoms of infections because steroids may mask a fever - correct answer All are correct EXCEPT they CANNOT play in any contact sports because it can cause traumas

EXAM QUESTIONS AND CORRECT ANSWER S|RASMUSSEN COLLEGE/GET IT 100% ACCURATE !! What are 2 general medical treatments for hematological disorders? - correct answer 1.Blood product transfusion 2.Hematopoetic stem cell transplantation (HSCT) 4 patients come into the transfusion center. Which patients get what transfusion based on their presenting problems? 1.Accute hemorrhage and trauma

2. Severe anemia, thalassemia, sickle cell disease
3. Hemophilia 4.Thrombocytopenia - correct answer 1. whole blood
4. packed red blood cells
5. fresh frozen plasma
6. platelets A new nurse is about to hang a blood transfusion for his patient. He is unsure of all the steps he has to follow for the transfusion to follow to prevent a reaction. What would all the 8 implications be to hang blood? - correct answer 1. Vital sign assessment including BP = 15 minutes pre transfusion for comparison and post transfusion. 15 minutes after initiation and hourly while blood is infusing and upon completion 2.check the identification of the recipient along with his/her blood type and group against the donor, regardless of the blood type being used 3.administer the first 50mL of blood or initial 20% of the volume slowly and stay with the child

EXAM QUESTIONS AND CORRECT ANSWER S|RASMUSSEN COLLEGE/GET IT 100% ACCURATE !!

4. administer with normal saline piggyback setup or have it available
5. administer blood through an appropriate filter and gently shake it frequently
6. use blood within 30 minutes of it arrival from blood bank. if there is a delay in the start of it, return it to the bank. DO NOT store it in the unit fridge.
7. infuse a unit of blood (or specified amount within 4 hours)
8. assess for signs and symptoms of a transfusion reaction A nurse checks on their patient who is receiving a blood transfusion. The patient complains of a sudden severe headache, chills but hot (has a fever), nausea/ vomiting, a tight feeling in their chest, pain at the needle site and in their vein, red or black urine when the went, and flank pain. The nurse is also seeing progressive signs of shock and/or renal failure. What is happening to their patient? - correct answer Transfusion reaction A nurse notices their patient is having a blood transfusion reaction. What are the appropriate steps they must take? - correct answer 1. STOP THE TRANSFUSION
9. Maintain a patent IV line and notify the doctor
10. save donor blood to recroscsmatch with the patients blood
11. monitor for evidence of shock
12. send samples of the patients urine to lab
13. observe for signs of hemorrhage

EXAM QUESTIONS AND CORRECT ANSWER S|RASMUSSEN COLLEGE/GET IT 100% ACCURATE !!

7. may administer acetaminophen or diphenhydramine
8. Transfusion may be restarted after medication administration depending on the type of transfusion Define hematopoietic stem cell transplantation (HSCT) and what are stem cells able to do? - correct answer - Uses harvested, unique immature cells (stem cells) to grow into new bone marrow producing cells

• Stem cells are able to differentiate into any type of hematologic cell Where are hematopoietic stem cells harvested from? - correct answer Bone marrow, peripheral blood, and umbilical blood What are the 2 types of stem cell transplant and their definitions? - correct answer Autologous = patients own stem cells are used Alogenic = stem cells from a donor are used Match the patient to the site of bone marrow harvesting (sites can be used more than once): Infant/young children Children over 5 Adults Tibia Iliac crest (pelvis) Sternum - correct answer Infant/ young children: tibia Children over 5: iliac crest (pelvis) Adults: sternum or iliac crest

EXAM QUESTIONS AND CORRECT ANSWER S|RASMUSSEN COLLEGE/GET IT 100% ACCURATE !! A nursing student is telling her instructor what she knows about bone marrow transplants. Which options may need more teaching? "It destroys the patients existing bone marrow" "It is a process of 7-10 days of high dose chemo and radiation" "The donated bone marrow is administered via central venous catheter" - correct answer NONE! all options are correct What complications can occur from bone marrow transplant or stem cell transplant? - correct answer GRAFT VS HOST DISEASE (GVHD) - risk with allogenic donor cells graft failure, infection, electrolyte imbalance, and bleeding A patient presents to the hospital with a maculopapular skin rash/ full thickness wounds, abdominal pain and cramps, nausea, vomiting, diarrhea, jaundice (and possible other liver problems), and elevated liver enzymes after receiving a transplant. What issue are they having?

• correct answer Graft vs host disease An acute infection is within the first 100 days The liver failure is an indication of serious illness with poor prognosis A nurse is treating a child with a hematologic disorder. The family and younger siblings are very involved in the child's life. What are the effects on the family that the nurse should be aware of? - correct answer Parents:
• the survival of the child
• Responsibility
• Child care
• Finiancial Siblings

EXAM QUESTIONS AND CORRECT ANSWER S|RASMUSSEN COLLEGE/GET IT 100% ACCURATE !!

• "What about me?"
• Magical thinking - feel like they could have caused it what are the most common cancers in children 0-14? - correct answer - leukemia
• brain and CNS tumors
• lymphomas
• soft tissue sarcomas (half are rhabdomyosarcoma)
• neuroblastoma
• kidney tumors What are the most common cancers in adolescents 15-19? - correct answer - Brain and CNS tumors
• lymphoma
• leukemia
• gonadal (testicular and ovarian)
• germ cell tumors
• thyroid cancer
• melanoma what tumors happen more frequently in African Americans and Caucasian? - correct answer AA- tumor of kidney and soft tissues C- tumor of bone A nursing student sees that a child is receiving a much longer chemo treatment than an adult and thinks that there is a mistake. Why is the student wrong? - correct answer Children need a longer treatment because they have a faster metabolic rate Characteristics of normal cells and their definitions. - correct answer Cell cycle - 5 phases differentiation - look the same but are actually different (EX: muscle cells- heart muscle different than skeletal muscle but they are all muscles) Cell inhibition - Cells contact each other, line up, grow to a certain point and then stop

EXAM QUESTIONS AND CORRECT ANSWER S|RASMUSSEN COLLEGE/GET IT 100% ACCURATE !! Cancer/ malignant cells flourish in what kind of environment? - correct answer antagonistic Characteristics of cancerous/ malignant cells - correct answer cancer cells don't follow rules of replication Larger and grow more rapidly bear little resemblance to host cells uncontrolled replication Adult vs. Pediatric Cancers - correct answer Adults: cancer is often the result of dietary issues or prolonged exposure to toxins from bad habits --> can be prevented through lifestyle changes Children: cancer is usually embryonic or oncogenic (cellular change that allows unregulated genetic activity and tumor growth) --> lifestyle changes have little effect on the incidence of childhood cancer A child presents to the hospital with an unusual mass/swelling, pallor, fatigue, unexplained bleeding/bruising/petechiae, persistent localized pain/limping, prolonged unexplained fever/illness, frequent headaches with vomiting, sudden eye and vision changes, and excessively rapid weight loss. What is the nurse suspecting the child may have? - correct answer cancer What diagnostic tests can the nurse anticipate the doctor ordering if cancer is suspected? - correct answer LAB: CBC, electrolytes, kidney, liver, and bone marrow function (bone marrow analysis and biopsy) Diagnostic procedures: lumbar puncture, bone marrow aspiration, tumor biopsy Diagnostic imaging: x-ray, CT, MRI, PET scan, MIBG scan (neuroblastoma and soft tissue tumor suspection) Why do we stage cancer? - correct answer staging describes the extent of the disease locally, regionally, and systemically and in most tumors guides the therapy

EXAM QUESTIONS AND CORRECT ANSWER S|RASMUSSEN COLLEGE/GET IT 100% ACCURATE !! A nursing student is learning about cancer staging and sees 3 letters that identify classification. TNM. What do those letters mean? And what do they identify? - correct answer T- Tumor N-Lymph M-Metastasis they identify protocol for treatment What are the 3 goals of cancer treatment and define them - correct answer Curative - rid the child's body of the cancer Supportive - interventions to assist the body's defenses and increase the child's comfort End of life - make the child as comfortable as possible when no curative treatment is possible A group of residents are discussing treatments for a child with cancer. What are all the methods the nurse could anticipate being ordered? - correct answer - Surgery

• Chemotherapy
• Radiotherapy (radiation)
• Biotherapy (Biologic response modifiers)
• Hematopoietic stem cell transplantation
• End of life care if curative doesn't work Why is surgery frequently a part of cancer therapy for children? - correct answer to obtain a biopsy tumor resection (partial or total) What other surgical procedures are done as part of cancer therapy? - correct answer Central venous catheter or implanted port placement A mother is upset her child needs an implanted port (Port-a-cath, infusaport, mediport, norport) for cancer treatment. What benefits could the nurse tell her about the implanted port to ease her anxiety? - correct answer - Reduced risk of infection
• Stable- not easily pulled out since it is placed completely under the skin

EXAM QUESTIONS AND CORRECT ANSWER S|RASMUSSEN COLLEGE/GET IT 100% ACCURATE !!

• Heparinized monthly and after each infusion to maintain patency and can remain in place for years
• No limitations on regular physical activity including swimming. Excluding vigorous contact sports
• Dressing needed only when Huber needle is in place
• only slight change in body appearance A child needs an implanted port for cancer treatments. He loves sports and wants to play football but is devastated when he finds out he can't. What statement by the nurse would be most appropriate? "Sorry you can't play football. You are sick and have to rest." "You are too young for a sport like that. How about you play with your trucks instead" "I am sorry you cant play football, but you are able to do another sport like swimming!" "You heard what the doctor said, no sports." - correct answer "I am sorry you cant play football, but you are able to do another sport like swimming!" What is an important topic of education for a child with an implanted port? - correct answer Signs and symptoms of infection - fever, redness, tachycardia What is AHRQ? - correct answer Agency for Healthcare Research and Quality A US governmental agency that functions as part of the department of health and human services (HHS) to support research to help improve the quality of healthcare What are pediatric quality indicators? - correct answer A set of measures that can be used with hospital inpatient discharge data to provide a perspective on the quality of pediatric health care AHRQ Pediatric Quality indicators: central venous catheter - related blood stream infection rate

EXAM QUESTIONS AND CORRECT ANSWER S|RASMUSSEN COLLEGE/GET IT 100% ACCURATE !! Description and exclusions - correct answer Description: (CLABSI) Central venous catheter related bloodstream infections (secondary diagnosis) per 1000 medical and surgical discharges for patients ages 17 years and younger Excludes cases with a principal diagnosis of a CLABSI present on admission, normal newborns, neonates with birthweight of less than 500 grams, cases with stays less than 2 days, and OB cases General Central venous catheter nursing interventions to prevent CLABSI - correct answer Perform hand hygiene procedures, either by washing hands with conventional soap and water or with alcohol based hand rubs A nursing manager is reading over the regimen of how to do an implanted port dressing change and notices something wrong on the sheet. Which item is incorrect?

• Sterile gauze or sterile, transparent, semipermeable dressing to cover the site
• The port can be submerged in water and no limitations on water activities or baths
• No recommendation on chlorhexidine-impregnated dressings for short term, non tunneled CVC for patients <18 years and non-premature neonates
• Wear either clean or sterile gloves - correct answer The port can be submerged in water and no limitations on water activities or baths IS INCORRECT!!!! Correction: do not submerge the catheter site in water, but showering should be permitted if catheter and connecting device are protected with impermeable cover How to cleanse a patient with an implanted port? - correct answer - Use a 2% chlorhexidine wash for daily skin cleansing (no recommendations for infants 0-2 months) Antibiotic Lock Prophylaxis, Antimicrobial Catheter Flush and Catheter Lock Prophylaxis
• Use prophylactic antimicrobial lock solution in patients with long term catheters who have a history of catheter related bsi

EXAM QUESTIONS AND CORRECT ANSWER S|RASMUSSEN COLLEGE/GET IT 100% ACCURATE !! Needless Intravascular Catheter Systems

• Change the needless components at least as frequently as the administration set
• minimize contamination risk by scrubbing the access port with an appropriate antiseptic and accessing the port only with sterile devices (15 sec scrub and 15 sec aridry)
• Use a needless system to access IV tubing Replacement of administration sets in implanted ports - correct answer - In patients not receiving blood, blood products, or fat emulsions, replace administration sets that are continuously used, not more frequently than at 96 hour intervals, bit at least every 7 days ~ infusions sets for blood, blood products, or fat emulsions (those combined with amino acids and glucose) or infused separately within 24 hours ~infusion sets for propofol change every 6-12 hours
• No recommendation made regarding frequency for replacing intermittently used administration sets
• No recommendation made regarding frequency for replacing needles to access implantable ports What is the administration of specific drugs that kill both normal and cancerous cells? - correct answer Chemotherapy How long are cancer drugs administered? - correct answer Until cancer cells are clinically undetectable when the patient is in "permanent remission" or "cure" True or false Normal cell DNA cannot replace itself after chemo because it is permanently damaged - correct answer FALSE!! Normal cell DNA CAN repair itself after chemo - cancer can't What are the 3 routes of administration for chemo? - correct answer oral, intrathecal (spinal), IV

EXAM QUESTIONS AND CORRECT ANSWER S|RASMUSSEN COLLEGE/GET IT 100% ACCURATE !! An adolescent is beginning chemotherapy treatments and is wanting to know all the side effects that they will experience. What are the side effects the nurse will tell the patient? - correct answer - Bone marrow suppression - Nadir is the time of greatest bone marrow suppression

• Nausea and vomiting - treated with antiemetics
• Anorexia and weight loss - nutritious food and dietary supplements
• Oral ulcers (oral mucositis) - antifungal treatment and lidocaine
• Constipation - stool softeners, increase fluids, encourage fiberous foods
• Pain - acetaminophen, opiates, and antidepressants. Avoid NSAIDS due to bleeding risk
• Alopecia - patient/parent education (hair return after 3-6 months and can look different) When administering chemotherapy, when do you start antiemetic therapy? - correct answer give first dose 30-60 minutes before chemo and administer for 1-2 days after to prevent nausea A mother states "If my child is having any pain from their chemo treatments I can administer aspirin or ibuprofen to help ease their pain." What would be the most appropriate answer by the nurse? "That sounds like a great idea! Im pleased you understood the teaching." "Do not administer those medications to them. They belong to a group of drugs called NSAIDS and can cause bleeding risk in your child. They can take acetaminophen instead." "I think it would be wise for you to read over the pamphlets again." "You can give that drug to them but make sure it is in low doses." - correct answer "Do not administer those medications to them. They belong to a group of drugs called NSAIDS and can cause bleeding risk in your child. They can take acetaminophen instead." What diet should a child on chemotherapy be eating? - correct answer Neutropenic diet - no microbes in food no fruits, vegetables, or yogurt except for fruits they can peel