Question 1

A child with rhabdomyosarcoma is to undergo radiation therapy after surgical removal of the tumor.The parents should be taught to:

Accepted Answer

The child should avoid sunlight as much as possible during radiation therapy, but if exposure is necessary, the area should be protected with sunscreen to prevent further damage.

Question 2

The nurse is admitting a client with an infratentorial brain tumor.The nurse is teaching the parents about the tumor.Identify the area of the brain the nurse should show the parents where this type of tumor occurs.

Accepted Answer

Correct placement of the mark is below the tentorium area (brainstem gliomas,medulloblastoma,cerebellar astrocytoma,ependymoma).Incorrect placement of the mark would be above the tentorium area (cerebral astrocytoma,ependymoma,optic nerve glioma).

Question 3

The child has been admitted to the hospital unit newly diagnosed with retinoblastoma.The nurse would expect to see:

Accepted Answer

A white pupil, also known as leukocoria, is a common symptom of retinoblastoma. It occurs when the tumor reflects light back instead of allowing it to pass through, giving the appearance of a white pupil instead of a red reflex. Yellow sclera and blue-tinged sclera are not typical signs of retinoblastoma. A red reflex is a normal finding in a healthy eye, but it may be absent in the affected eye of a child with retinoblastoma.

Question 4

A child has thrombocytopenia secondary to chemotherapy treatments.The nurse should not:

Accepted Answer

Administering intramuscular injections can cause bleeding and bruising in a child with thrombocytopenia. Alternative routes of medication administration should be considered.

Question 5

The nurse is monitoring the urine-specific gravity and pH of a child receiving chemotherapy.The nurse will try to maintain the urine values at:

Accepted Answer

A urine specific gravity of 1.005 and a pH of 7.5 are ideal for a child receiving chemotherapy. This is because a lower specific gravity indicates a more dilute urine, which helps prevent the precipitation of chemotherapy metabolites that could lead to kidney damage. A slightly alkaline pH (7.5) helps prevent the crystallization of certain chemotherapy drugs and their metabolites, further protecting the kidneys.

Question 6

A child has been diagnosed with Wilms' tumor,and is being treated with chemotherapy.Because many chemotherapeutic agents cause bone marrow depression,before administering the chemotherapy,the nurse will determine if this child has any infection-fighting capability by monitoring the:

Accepted Answer

The absolute neutrophil count (ANC) measures the number of neutrophils in the blood, which are a type of white blood cell that fights infection. Chemotherapy can cause bone marrow depression, which can decrease the number of neutrophils in the blood and increase the risk of infection. Therefore, monitoring the ANC is important to determine if the child has any infection-fighting capability before administering chemotherapy. Hemoglobin, red blood cell count, and platelets are important measures of the child's anemia and clotting ability, but do not directly assess infection-fighting capability.

Question 7

A child undergoing chemotherapeutic treatment for cancer is being admitted to the hospital for fever and possible sepsis.Cultures,antibiotics,and acetaminophen (Tylenol)have been ordered for this child.Which order should the nurse do first?

Accepted Answer

Obtaining the cultures should be done first to identify the source of the fever and sepsis. This is important in order to administer the appropriate antibiotics. Administering antibiotics or Tylenol before obtaining cultures could alter the results and make it more difficult to determine the source of infection.

Question 8

An adolescent is receiving methotrexate chemotherapy after undergoing limb salvage surgery for osteogenic sarcoma.The nurse knows the teen understands the purpose of leucovorin therapy after the methotrexate if the teen says:

Accepted Answer

Leucovorin is given after methotrexate chemotherapy to prevent or reduce the severity of side effects. The correct statement by the teen indicates an understanding that multiple doses of leucovorin will be needed over a period of time, rather than one-time dosing.

Question 9

A child has cancer,and has been treated with chemotherapy.The latest lab value indicates the white blood cell count is very low.The nurse would expect to administer:

Accepted Answer

Filgrastim (Neupogen) is a medication used to stimulate the production of white blood cells, which would be the most appropriate treatment for a low white blood cell count after chemotherapy. Ondansetron (Zofran) is used to alleviate nausea and vomiting, but would not be helpful in this situation. Oprelvekin (Neumega) is used to increase platelet counts and would not affect white blood cell counts. Epoetin (human recombinant erythropoietin) is used to stimulate the production of red blood cells and would not affect white blood cell counts.

Question 10

A child recently has been diagnosed with leukemia.The child's sibling is expressing feelings of anger and guilt.This reaction by the sibling is:

Accepted Answer

It is normal for a sibling to feel anger and guilt when their brother or sister is diagnosed with a serious illness such as leukemia. The sibling may feel guilty they didn't do enough to prevent the illness or angry that such a terrible thing could happen to their loved one. It is important for the sibling to receive emotional support and understanding during this difficult time.

Question 11

A preschool-age child is being seen in the oncology clinic for a suspected diagnosis of cancer.A common reaction preschool-age children have to a diagnosis of cancer is:

Accepted Answer

Preschool-age children may have a limited understanding of illness and may view their illness as a punishment for something they did wrong. It is important for healthcare providers to address these feelings and reassure the child that they did not cause their illness.

Question 12

The child is receiving chemotherapy for acute lymphocytic leukemia.The nurse should monitor the child for which of the following signs of tumor lysis syndrome?

Accepted Answer

Tumor lysis syndrome can occur as a result of chemotherapy in certain types of cancers, including acute lymphocytic leukemia. It is characterized by the rapid breakdown of cancer cells, which leads to the release of large amounts of intracellular contents into the bloodstream. This can cause metabolic abnormalities, particularly hyperuricemia, hyperkalemia, and hyperphosphatemia, which can lead to significant renal impairment and electrolyte imbalances. Oliguria and altered levels of consciousness are two potential signs of tumor lysis syndrome, as they can result from the combination of electrolyte imbalances and renal impairment. Thrombocytopenia and leukocytosis, respiratory distress and cyanosis, upper-extremity edema, and neck vein distension are not typically associated with tumor lysis syndrome.

Question 13

A child has been diagnosed with Wilms' tumor.Preoperative nursing care would involve:

Accepted Answer

Preoperative nursing care for a child with Wilms' tumor would involve careful bathing and handling to prevent injury to the tumor and the fragile blood vessels surrounding it. Monitoring behavioral status and administering packed red blood cells are not specific to the care of a child with Wilms' tumor. Maintenance of strict isolation is not necessary as Wilms' tumor is not contagious.

Question 14

A school-age child is being seen in the oncology clinic for possible Hodgkin's disease.During the course of the nursing assessment,which findings would be expected? Select all that apply.

Accepted Answer

Fever, painless cervical nodes, and complaints of night sweats are all expected findings in a school-age child being seen in the oncology clinic for possible Hodgkin's disease.

Question 15

A 24-hour urine for vanillylmandelic acid (VMA)has been ordered on a child suspected of having neuroblastoma.The nurse begins the collection:

Accepted Answer

In order to ensure an accurate result, the nurse should begin the collection after the next time the child voids. This allows for a complete sample to be collected and reduces the risk of contamination.

Quiz 52: The Child With Cancer