A nurse is caring for a child with newly diagnosed acute lymphoblastic leukemia. What clinical findings does the nurse anticipate when assessing the child? Select all that apply.
Fatigue
Generalized edema
Pallor
Jaundice
Multiple bruises
Correct Answer : A,C,E
A. Fatigue: Children with ALL often experience fatigue and weakness due to decreased red blood cell and platelet production as a result of bone marrow involvement by leukemia cells.
C. Pallor: Pallor, or paleness, is a common finding in children with ALL because of anemia (reduced red blood cell count).
E. Multiple bruises: Children with ALL may have an increased tendency to bruise and bleed due to low platelet counts, making them susceptible to easy bruising and petechiae.
The other options, B (Generalized edema) and D (Jaundice), are not typical clinical findings associated with ALL. Generalized edema is not a common symptom, and jaundice (yellowing of the skin and eyes) is more commonly associated with liver conditions, not leukemia.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Continuing to offer a special formula to limit gagging is not a standard approach in the care of infants with cerebral palsy. The choice of formula should be based on the child's nutritional needs, and any feeding difficulties should be addressed by a healthcare professional.
B. Maintaining immobility of the limbs with splints is not recommended. Encouraging movement and mobility is important for the development and well-being of children with cerebral palsy.
C. Preserve muscle tone to prevent joint contractures.
Cerebral palsy is a condition that can lead to problems with muscle tone and movement. Preserving muscle tone is important to prevent joint contractures, which can limit mobility and cause pain. Physical therapy and exercises can help maintain muscle tone and joint flexibility in children with cerebral palsy.
D. Focusing on cognitive rather than motor skills is not appropriate. Motor skills are a crucial aspect of development for children with cerebral palsy. The approach should encompass both cognitive and motor skill development as appropriate for the child's age and abilities.
Correct Answer is ["A","B","C","E"]
Explanation
A. Monitoring level of consciousness (LOC): Monitoring the child's level of consciousness is essential as changes in LOC can be an important indicator of the progression of meningitis.
B. Administration of IV antibiotics: Antibiotics are a critical component of the treatment for bacterial meningitis. Early administration of appropriate antibiotics is crucial to control the infection.
C. Decreasing environmental stimuli: Reducing environmental stimuli, such as noise and light, can help minimize discomfort and agitation in a child with meningitis.
D. Increasing IV fluids above maintenance is not typically part of the standard management of bacterial meningitis. Maintaining hydration and electrolyte balance is important, but increasing fluids significantly above maintenance may not be necessary and should be determined based on the child's clinical condition.
E. Instituting droplet precautions: Bacterial meningitis is contagious, and it is important to isolate the child and implement appropriate infection control measures, including droplet precautions, to prevent the spread of the infection to others.
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