Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is reviewing the complete blood count results for a 4-year-old child who is receiving treatment for acute lymphoblastic leukemia. Which of the following findings should indicate to the nurse that the treatment is having a therapeutic effect?
A. Hemoglobin 6.8 g/dL (9.5 to 14 g/dL)
A low hemoglobin level indicates anemia, which is common in leukemia but does not necessarily indicate treatment effectiveness.
B. Platelet count 98,000/mm3 (150,000 to 400,000/mm3)
A low platelet count is a sign of bone marrow suppression, which is a common side effect of chemotherapy for leukemia.
C. RBC count 5/mm3 (4 to 5.5/mm3)
A normal RBC count indicates that the child's bone marrow is producing enough red blood cells to carry oxygen throughout the body.
D. WBC count 15,000/mm3 (5,000 to 10,000/mm3)
Elevated WBC count is typical in leukemia and does not necessarily indicate treatment effectiveness.
This question is an excerpt from Nurse Dive's nursing test bank - Rn Pediatric Nursing 2023 Proctored Exam. Take the full exam now
Full Explanation
A. A low hemoglobin level indicates anemia, which is common in leukemia but does not necessarily indicate treatment effectiveness.
B. A low platelet count is a sign of bone marrow suppression, which is a common side effect of chemotherapy for leukemia.
C. A normal RBC count indicates that the child's bone marrow is producing enough red blood cells to carry oxygen throughout the body.
D. Elevated WBC count is typical in leukemia and does not necessarily indicate treatment effectiveness.
Similar Questions
A nurse is caring for a child who is receiving conditioning therapy for enuresis. Which of the following statements by the child's parent indicate the treatment is effective?
A. "My child held their urine for about 15 minutes before going to the bathroom."
Holding urine for extended periods may indicate urinary retention, which is not the desired outcome of treatment for enuresis.
B. "My child has been drinking a lot less since they started treatment."
Drinking less may not necessarily indicate treatment effectiveness and could lead to dehydration.
C. "My child went to the bathroom two times when the alarm went off last night."
Waking to urinate in response to the alarm indicates improved bladder control and responsiveness to conditioning therapy for enuresis.
D. "My child has been doing Kegel exercises to strengthen their pelvic muscles."
Kegel exercises primarily target pelvic floor muscles and may not directly address the underlying causes of enuresis.
Full Explanation
A. Holding urine for extended periods may indicate urinary retention, which is not the desired outcome of treatment for enuresis.
B. Drinking less may not necessarily indicate treatment effectiveness and could lead to dehydration.
C. Waking to urinate in response to the alarm indicates improved bladder control and responsiveness to conditioning therapy for enuresis.
D. Kegel exercises primarily target pelvic floor muscles and may not directly address the underlying causes of enuresis.
A nurse is caring for a client who is postoperative following placement of a halo vest to manage a cervical vertebral fracture. Which of the following actions should the nurse take?
A. Encourage flexion and extension of the neck.
The nurse should not encourage flexion and extension of the neck, as this could cause further injury or damage to the spinal cord.
B. Reposition the client using a turning sheet.
The nurse should reposition the client using a turning sheet to prevent skin breakdown and maintain alignment of the spine.
C. Assess the pin sites for infection once every other day.
The nurse should assess the pin sites for infection at least once a day, not every other day.
D. Tighten the screws on the halo device one-quarter turn every 48 hr.
The nurse should not tighten the screws on the halo device, as this could cause pressure ulcers or nerve damage. Only a provider can adjust the screws on the halo device.
Full Explanation
A. The nurse should not encourage flexion and extension of the neck, as this could cause further injury or damage to the spinal cord.
B. The nurse should reposition the client using a turning sheet to prevent skin breakdown and maintain alignment of the spine.
C. The nurse should assess the pin sites for infection at least once a day, not every other day.
D. The nurse should not tighten the screws on the halo device, as this could cause pressure ulcers or nerve damage. Only a provider can adjust the screws on the halo device.
A nurse is assessing a school-age child who is receiving morphine. For which of the following adverse effects should the nurse monitor?
A. Stevens-Johnson syndrome
Stevens-Johnson syndrome is a severe, rare, and potentially life-threatening reaction that can occur as a hypersensitivity reaction to certain medications. However, it is not typically associated with morphine use.
B. Hypertension
Morphine is more commonly associated with hypotension rather than hypertension. Therefore, while monitoring for changes in blood pressure is important, hypertension is not a primary concern with morphine administration.
C. Prolonged wound healing
Morphine use is not typically associated with prolonged wound healing. However, it can cause respiratory depression, which can indirectly affect wound healing by reducing tissue oxygenation.
D. Bradypnea
Morphine is a potent opioid analgesic that can cause respiratory depression, leading to bradypnea (slow breathing) or even respiratory arrest. Monitoring respiratory rate is crucial when administering morphine to detect signs of respiratory depression early and intervene promptly.
Full Explanation
A. Stevens-Johnson syndrome is a severe, rare, and potentially life-threatening reaction that can occur as a hypersensitivity reaction to certain medications. However, it is not typically associated with morphine use.
B. Morphine is more commonly associated with hypotension rather than hypertension. Therefore, while monitoring for changes in blood pressure is important, hypertension is not a primary concern with morphine administration.
C. Morphine use is not typically associated with prolonged wound healing. However, it can cause respiratory depression, which can indirectly affect wound healing by reducing tissue oxygenation.
D. Morphine is a potent opioid analgesic that can cause respiratory depression, leading to bradypnea (slow breathing) or even respiratory arrest. Monitoring respiratory rate is crucial when administering morphine to detect signs of respiratory depression early and intervene promptly.