Page 939 - Saunders Comprehensive Review For NCLEX-RN

Reference: McKinney et al. (2018), pp. 1151-1152.

320. Answer: 4

Rationale: Hodgkin’s disease (a type of lymphoma) is a malignancy of the lymph
nodes. The presence of giant, multinucleated cells (Reed-Sternberg cells) is the classic
characteristic of this disease. Elevated levels of vanillylmandelic acid in the urine
may be found in children with neuroblastoma. The presence of blast cells in the bone
marrow indicates leukemia. Epstein-Barr virus is associated with infectious
mononucleosis.
Test-Taking Strategy: Focus on the subject, confirmatory diagnostic tests for
Hodgkin’s disease. Think about the pathophysiology associated with Hodgkin’s
disease. Remember that the Reed-Sternberg cell is characteristic of Hodgkin’s
disease.
Level of Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Assessment
Content Area: Pediatrics: Oncological
Health Problem: Pediatric-Specific: Cancers
Priority Concepts: Cellular Regulation; Clinical Judgment
Reference: Hockenberry, Wilson, Rodgers (2017), pp. 829-830.

321. Answer: 2, 3, 4

Rationale: Leukemia is a malignant increase in the number of leukocytes, usually
at an immature stage, in the bone marrow. It affects the bone marrow, causing
anemia from decreased erythrocytes, infection from neutropenia, and bleeding from
decreased platelet production (thrombocytopenia). A common complication of
treatment for leukemia is overwhelming infection secondary to neutropenia.
Measures to prevent infection include the use of a private room, strict aseptic
technique, restriction of visitors and health care personnel with active infection, strict
hand washing, ensuring that anyone entering the child’s room wears a mask, and
reducing exposure to environmental organisms by eliminating raw fruits and
vegetables from the diet and fresh flowers from the child’s room and by not leaving
standing water in the child’s room. Applying firm pressure to a needle-stick area for
at least 10 minutes is a measure to prevent bleeding.
Test-Taking Strategy: Focus on the subject, preventing infection. Reading each
intervention carefully and keeping this subject in mind will assist in answering the
question. A semiprivate room places the child at risk for infection. Applying firm
pressure to a needle-stick area is related to preventing bleeding.
Level of Cognitive Ability: Analyzing
Client Needs: Safe and Effective Care Environment
Integrated Process: Nursing Process—Implementation
Content Area: Pediatrics: Oncological
Health Problem: Pediatric-Specific: Cancers
Priority Concepts: Infection; Safety
Reference: McKinney et al. (2018), pp. 1151-1152.

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