Question 1

A child had surgery for a brain tumor.Which provider orders does the nurse question?&#10;A) Place the child in the Trendelenburg position.&#10;B) Perform neurologic assessments.&#10;C) Assess dressings for drainage.&#10;D) Monitor temperature.

Accepted Answer

The child is never placed in the Trendelenburg position because it increases intracranial pressure and the risk of bleeding.Increased intracranial pressure is a risk in the postoperative period.The nurse would assess the child's neurologic status frequently.Hemorrhage is a risk in the postoperative period.The child's dressing would be inspected frequently for bleeding.Temperature is monitored closely because the child is at risk for infection in the postoperative period.

Question 2

Parents of a child with acute lymphoblastic leukemia (ALL)ask about their child's prognosis.The nurse should base the response on the knowledge that&#10;A) leukemia is a fatal disease, although chemotherapy provides increasingly longer periods of remission.&#10;B) research to find a cure for childhood cancers is very active.&#10;C) the majority of children go into remission and remain symptom free when treatment is completed.&#10;D) it usually takes several months of chemotherapy to achieve a remission.

Accepted Answer

Children diagnosed with the most common form of leukemia,ALL,can almost always achieve remission,with a 5-year disease-free survival rate approaching 85%.With the majority of children surviving 5 years or longer,it is inappropriate to refer to leukemia as a fatal disease.Telling parents about current research to Answerwer their question does not address their concern.About 95% of children achieve remission within the first month of chemotherapy.

Question 3

The nurse understands that the types of precautions needed for children receiving chemotherapy are based on which action of chemotherapeutic agents?&#10;A) Gastrointestinal upset&#10;B) Bone marrow suppression&#10;C) Decreased creatinine level&#10;D) Alopecia

Accepted Answer

Chemotherapy agents cause bone marrow suppression,which creates the need to institute precautions related to reduced white blood cell,red blood cell,and platelet counts.These precautions focus on preventing infection and bleeding.Although gastrointestinal upset may be an adverse effect of chemotherapy,it is not caused by all chemotherapeutic agents.No special precautions are instituted for gastrointestinal upset.A decreased creatinine level is consistent with renal pathologic conditions,not chemotherapy.Not all chemotherapeutic agents cause alopecia.No precautions are taken to prevent alopecia.

Question 4

A child with a history of fever of unknown origin,excessive bruising,lymphadenopathy,anemia,and fatigue is exhibiting symptoms most suggestive of which of the following?&#10;A) Ewing sarcoma&#10;B) Wilms' tumor&#10;C) Neuroblastoma&#10;D) Leukemia

Accepted Answer

These symptoms reflect bone marrow failure and organ infiltration,which occur in leukemia.Symptoms of Ewing sarcoma involve pain and soft tissue swelling around the affected bone.Wilms' tumor usually manifests as an abdominal mass with abdominal pain and may include renal symptoms,such as hematuria,hypertension,and anemia.Neuroblastoma manifests primarily as an abdominal,chest,bone,or joint mass.Symptoms are dependent on the extent and involvement of the tumor.

Question 5

A child with acute myeloblastic leukemia is scheduled to have a bone marrow transplant (BMT).The donor is the child's own umbilical cord blood that had been previously harvested and banked.This type of BMT is termed

A) autologous.
B) allogeneic.
C) syngeneic.
D) stem cell.

Accepted Answer

In an autologous trAnswerplant,the child's own marrow or previously harvested and banked cord blood is used.In an allogeneic BMT,histocompatibility has been matched with a related or an unrelated donor.In a syngeneic trAnswerplant,the child receives bone marrow from an identical twin.A stem cell trAnswerplantation uses a unique immature cell present in the peripheral circulation.

Question 6

Children with non-Hodgkin lymphoma are at risk for complications resulting from tumor lysis syndrome (TLS).What findings would the nurse assess for to identify this complication early?&#10;A) Increased ALT, AST&#10;B) Change in level of consciousness&#10;C) Elevated BUN and creatinine&#10;D) Oxygen saturation of 93%

Accepted Answer

In TLS,the tumor's intracellular contents are dumped into the child's extracellular fluid as the tumor cells are lysed in response to chemotherapy.Because of the large volume of these cells,their intracellular electrolytes overload the kidneys and,if not monitored,can cause kidney failure.Kidney failure would manifest in rising BUN and creatinine.This does not affect the liver so increased ALT and AST are not related.Changes in level of consciousness would not help identify this specific complication.An oxygen saturation of 93% is related to the lungs.

Question 7

The nurse notes that a child's gums bleed easily and that the child has bruising and petechiae on his extremities.What laboratory values are consistent with these symptoms?&#10;A) Platelet count of 19,000/mm3&#10;B) Prothrombin time of 11 to 15 seconds&#10;C) Hematocrit of 34&#10;D) Leukocyte count of 14,000/mm3

Accepted Answer

The normal platelet count is 150,000 to 400,000/mm³.This finding is very low,indicating an increased bleeding potential.The child should be monitored closely for signs of bleeding.The prothrombin time of 11 to 15 seconds is within normal limits.The normal hematocrit is 35 to 45,and although this finding is low,it would not create the symptoms presented.This value indicates the probable presence of infection,but it is not a reflection of bleeding tendency.

Question 8

A child has just been diagnosed with acute lymphoblastic leukemia,and the mother is expressing guilt about not taking the child to the doctor right away.What response by the nurse is best?&#10;A) &#34;Always call the physician when your child has a change in what is normal for him.&#34;&#10;B) &#34;It is better to be safe than sorry.&#34;&#10;C) &#34;It is common for parents not to notice subtle changes in their children's health.&#34;&#10;D) &#34;I hope this delay does not affect the treatment plan.&#34;

Accepted Answer

This statement is not only true,but it will also help minimize the mother's guilt and help establish a therapeutic relationship with the nurse.Identifying concerns and clarifying misconceptions will help families cope with the stress of chronic illness.

Question 9

A child with non-Hodgkin lymphoma will be starting chemotherapy.What intervention is initiated before chemotherapy to prevent tumor lysis syndrome?&#10;A) Insertion of a central venous catheter&#10;B) Intravenous (IV) hydration containing sodium bicarbonate&#10;C) Placement of an externalized ventriculoperitoneal (VP) shunt&#10;D) Administration of pneumococcal and Haemophilus influenzae type B vaccines

Accepted Answer

Intensive hydration with an IV fluid containing bicarbonate alkalinizes the urine to help prevent the formation of uric acid crystals,which damage the kidney.A central venous catheter is placed to assist in delivering chemotherapy.An externalized VP shunt may be placed to relieve intracranial pressure caused by a brain tumor.If a splenectomy is necessary for a child with Hodgkin disease,the pneumococcal and Haemophilus influenzae vaccines are administered before the surgery.

Question 10

What should the nurse teach parents about oral hygiene for the child receiving chemotherapy?&#10;A) Brush the teeth briskly to remove bacteria.&#10;B) Use a mouthwash that contains alcohol.&#10;C) Inspect the child's mouth daily for ulcers.&#10;D) Perform oral hygiene twice a day.

Accepted Answer

The child's mouth is inspected regularly for ulcers.At the first sign of ulceration,an antifungal drug is initiated.The teeth should be brushed with a soft-bristled toothbrush.Excessive force with brushing should be avoided because delicate tissue could be broken,causing infection or bleeding.Mouthwashes containing alcohol may be drying to oral mucosa,thus breaking down the protective barrier of the skin.Oral hygiene should be performed four times a day.

Question 11

The nurse is aware that an abdominal mass found in a 10-month-old infant corresponds with which childhood cancer?&#10;A) Osteogenic sarcoma&#10;B) Rhabdomyosarcoma&#10;C) Neuroblastoma&#10;D) Non-Hodgkin lymphoma

Accepted Answer

The answer of The nurse is aware that an abdominal...

Question 12

A nurse has taught parents about diagnostic testing for their child who is suspected of having leukemia.What test described by the parents shows good understanding of this information?&#10;A) Complete blood cell count (CBC)&#10;B) Lumbar puncture&#10;C) Bone marrow biopsy&#10;D) Computed tomography (CT) scan

Accepted Answer

The answer of A nurse has taught parents about diagnostic...

Question 13

Which clinical finding is an overt sign of retinoblastoma in children?&#10;A) Whitish reflex in the eye&#10;B) Lymphadenopathy&#10;C) Bone pain&#10;D) Change in gait

Accepted Answer

The answer of Which clinical finding is an overt sign...

Question 14

What is an expected physical assessment finding for an adolescent with a diagnosis of Hodgkin disease?&#10;A) Protuberant, firm abdomen&#10;B) Enlarged, painless, firm cervical lymph nodes&#10;C) Soft tissue swelling&#10;D) Soft to hard, nontender mass in pelvic area

Accepted Answer

The answer of What is an expected physical assessment finding...

Question 15

A nurse has taught the parents about home care of their child who has leukemia.Which statement made by the parents indicates an understanding of this teaching?&#10;A) &#34;We will take our child's blood pressure daily.&#34;&#10;B) &#34;We will restrict fluids in case there is central nervous system involvement.&#34;&#10;C) &#34;We will make sure our child gets all immunizations in a timely manner.&#34;&#10;D) &#34;We will take our child's temperature frequently.&#34;

Accepted Answer

The answer of A nurse has taught the parents about...

Question 16

The nurse notes a reddened area on the forearm of a neutropenic child with leukemia.What action by the nurse is most appropriate?&#10;A) Massage the area.&#10;B) Turn the child more frequently.&#10;C) Document the finding and continue to observe the area.&#10;D) Notify the provider.

Accepted Answer

The answer of The nurse notes a reddened area on...

Question 17

What is an appropriate nursing action before surgery when caring for a child diagnosed with a Wilms' tumor?&#10;A) Limit fluid intake.&#10;B) Do not palpate the abdomen.&#10;C) Force oral fluids.&#10;D) Palpate the abdomen every 4 hours.

Accepted Answer

The answer of What is an appropriate nursing action before...

Question 18

While completing an assessment on a 6-month-old infant,which finding should the nurse recognize as a symptom of a brain tumor?&#10;A) Blurred vision&#10;B) Increased head circumference&#10;C) Vomiting when getting out of bed&#10;D) Headache

Accepted Answer

The answer of While completing an assessment on a 6-month-old...

Question 19

What is a priority nursing diagnosis for the 4-year-old child newly diagnosed with leukemia?&#10;A) Ineffective Breathing Pattern related to mediastinal disease&#10;B) Risk for Infection related to immunosuppressed state&#10;C) Disturbed Body Image related to alopecia&#10;D) Impaired Skin Integrity related to radiation therapy

Accepted Answer

The answer of What is a priority nursing diagnosis for...

Question 20

Hematopoietic stem cell transplantation (HSCT)is the standard treatment for a child in his or her first remission with what cancer?&#10;A) Acute lymphocytic leukemias&#10;B) Non-Hodgkin lymphoma&#10;C) Wilms' tumor&#10;D) Acute myeloblastic leukemia (AML)

Accepted Answer

The answer of Hematopoietic stem cell transplantation (HSCT)is the standard...

Question 21

When an adolescent with a new diagnosis of Ewing sarcoma asks the nurse about treatment,the nurse's response is based on the knowledge that (Select all that apply.)&#10;A) this type of tumor invades the bone.&#10;B) management includes chemotherapy, surgery, and radiation.&#10;C) Ewing sarcoma is usually not responsive to either chemotherapy or radiation.&#10;D) affected bones such as ribs and proximal fibula may be removed to excise the tumor.&#10;E) is the most common bone tumor seen in children.

Accepted Answer

The answer of When an adolescent with a new diagnosis...

Question 22

A child is in the hospital receiving chemotherapy,and the nurse suspects the child has an infection.What action by the nurse takes priority?&#10;A) Monitor the child's temperature.&#10;B) Assess the daily white blood cell count.&#10;C) Administer antibiotics.&#10;D) Obtain blood and urine cultures.

Accepted Answer

The answer of A child is in the hospital receiving...

Question 23

A nurse routinely administers chemotherapy to hospitalized children with cancer.What safety measures does this nurse take as a routine part of practice? (Select all that apply.)&#10;A) Calculates child's body-surface area in meters squared&#10;B) Ensures a CBC is obtained within 72 hours of starting chemotherapy&#10;C) Double checks ordered doses against established protocols&#10;D) Obtains emergency equipment&#10;E) Monitors child based on provider orders

Accepted Answer

The answer of A nurse routinely administers chemotherapy to hospitalized...

Question 24

A child with a brain tumor is undergoing radiation therapy.What should the nurse include in the discharge instructions to the child's parents? (Select all that apply.)&#10;A) Apply over-the-counter creams to the area daily.&#10;B) Avoid excessive skin exposure to the sun.&#10;C) Use a washcloth when cleaning the area receiving radiation.&#10;D) Plan for adequate rest periods for the child.&#10;E) A darkening of the skin receiving radiation is expected.

Accepted Answer

The answer of A child with a brain tumor is...

Question 25

A child has a brain tumor.What assessment finding leads the nurse to request a physical therapy consultation?&#10;A) Dizziness&#10;B) Ataxia&#10;C) Slurred speech&#10;D) Visual changes

Accepted Answer

The answer of A child has a brain tumor.What assessment...

Question 26

What fluid is the best choice when a child with mucositis asks for something to drink?&#10;A) Hot chocolate&#10;B) Lemonade&#10;C) Popsicle&#10;D) Orange juice

Accepted Answer

The answer of What fluid is the best choice when...

Question 27

What should the nurse recognize as symptoms of a brain tumor in a school-age child? (Select all that apply.)&#10;A) Blurred vision&#10;B) Increased head circumference&#10;C) Vomiting when getting out of bed&#10;D) Intermittent headache&#10;E) Declining academic performance

Accepted Answer

The answer of What should the nurse recognize as symptoms...

Deck 48: The Child with Cancer