Deck 33: Caring for the Child With Cancer

Question 1

A nurse sees the term "proptosis" in a child's medical record.Which physical assessment does the nurse plan to incorporate into the child's exam based on this finding?

A)Balance testing
B)Hearing screen
C)Visual acuity
D)Strength testing

Answer 1

Visual acuity

Question 2

A nursing student is caring for a child diagnosed with Wilms' tumor.Which action by the student causes the faculty member to intervene?

A)Assesses urinary output per protocol
B)Involves the parents in the child's care
C)Palpates the abdomen in all four quadrants
D)Provides frequent nutritious snacks

Answer 2

Palpates the abdomen in all four quadrants

Question 3

A nurse hears that a new admission to the hospital was recently diagnosed with the most common kind of childhood cancer.Which collaborative care does the nurse prepare to provide to this patient?

A)Antibiotic administration
B)Bone marrow transplant
C)Chemotherapy
D)Liver transplant

Answer 3

Chemotherapy

Question 4

A nurse is caring for a child who is scheduled to have intrathecal chemotherapy today.Which action by the nurse is most important when providing care to this patient and family?

A)Educating family on side effects of chemotherapy
B)Ensuring a signed consent is on the chart
C)Providing distraction techniques during the process
D)Reassuring the child the parents will be present

Question 5

A nurse is caring for a child who has acute lymphocytic leukemia and has been treated with doxorubicin (Adriamycin).Which assessment finding would the nurse report immediately?

A)Loss of appetite
B)Low WBC count
C)Peripheral edema
D)Temperature of 100.6°F (38.1°C),once

Question 6

A nurse notes in a patient's medical record high levels of vanillymandelic acid (VMA).Based on this information,which condition does the nurse prepare to educate the patient and family about?

A)Ewing's sarcoma
B)Hodgkin's lymphoma
C)Neuroblastoma
D)Wilms' tumor

Question 7

An 8-year-old child has been diagnosed with a brain tumor.Based on knowledge of childhood cancers,which intervention does the nurse plan to implement when the child is admitted to the hospital?

A)Aspiration precautions
B)Protective isolation
C)Safety precautions
D)Seizure precautions

Question 8

A neutropenic child is admitted to the hospital and placed in protective isolation.Which instruction does the nurse give the family to help maintain a safe environment for the child?

A)Do not let the child have chewing gum
B)Flowers,plants,and produce are not allowed
C)The child can only have one visitor at a time
D)Toys and items from home cannot be brought in

Question 9

A nursing student asks the faculty member to explain an oncogene.Which response by the faculty member is the most appropriate?

A)A cell that changes into a malignancy after environmental stress
B)Any gene found inside a solid tumor that can be removed for biopsy
C)A gene in a virus that encourages malignant transformation in cells
D)An inherited gene that is programmed to become a malignant cell

Question 10

A clinic nurse notes that a child brought in for a physical has swelling and bruising around the eyes.The patient denies any trauma and the parent reports no environmental allergies.Which assessment is most important?

A)Auscultate lungs bilaterally.
B)Inspect skin on the back.
C)Palpate abdomen and neck.
D)Percuss abdomen and flank.

Question 11

A parent brings a child to the clinic and reports that the child is reluctant to walk and has a new limp.The parent also reports that the child seems lethargic and tired all the time.The nurse notes that the child appears pale.Which other finding would warrant immediate notification of the health-care provider?

A)Difficulty staying asleep at night
B)Left-sided abdominal enlargement
C)Polyphagia and polydipsia
D)Swelling of the legs and feet

Question 12

A nursing faculty member explains to the class that which item is the most important for tumor cell growth?

A)Age of transforming cells
B)Programmed cell death
C)Proximity to a capillary
D)Rapidity of cell growth

Question 13

A child is 2 hours postoperative after a resection of a brain tumor.Which assessment by the nurse takes priority?

A)Blood pressure
B)Intake and output
C)Neurological exam
D)Temperature

Question 14

A child has been diagnosed with chronic myelogenous leukemia (CML).Which statement by the nurse to the parents is most appropriate?

A)"Radiation therapy is the standard treatment."
B)"The prognosis for this disease is extremely poor."
C)"There are lots of good medications for nausea."
D)"We need to test siblings for a bone marrow match."

Question 15

A 7-year-old child presents to the emergency department,where the parent reports a 3-week history of pale skin,extreme fatigue,and dizziness.Which laboratory value would the nurse correlate with the patient's current condition?

A)Hematocrit: 33%
B)Hemoglobin: 13.2 g/dL
C)Red blood cell count: 2.8/mm3
D)White blood cell count: 12.3/mm3

Question 16

A nurse is reviewing a patient's chart and notes that the patient has a cancerous tumor that has invaded other organs.Based on this information,at which stage is this patient's cancer classified?

A)Stage O
B)Stage I
C)Stage III
D)Stage IV

Question 17

A nurse is looking at photographs of a friend's infant.The nurse notes a whitish glow in the child's eyes,and the friend asks why the baby's eyes look so odd.Which response by the nurse is the most appropriate?

A)"If his eyes look like this by 6 months,he needs to see a doctor."
B)"Take him to the doctor to see what's wrong with his eyes."
C)"This is called leukocoria and may signify retinoblastoma."
D)"Your baby may have a brain tumor;take him to the hospital."

Question 18

A child is admitted and is scheduled to receive intravenous asparginase (Elspar).Which action by the nurse is most important when administering this medication?

A)Arranging an outpatient hearing test
B)Having emergency drugs on hand
C)Monitoring the child's intake and output
D)Providing anti-emetic drugs as needed

Question 19

A 4-year-old child is several days postoperative after a resection of a brain tumor.The nurse finds the child irritable and lethargic,and notes that she has vomited.Which medication does the nurse anticipate administering?

A)Dexamethasone (Decadron)
B)Fosphenytoin (Cerebyx)
C)Odansetron (Zofran)
D)Phenytoin (Dilantin)

Question 20

A child is being discharged after surgical resection of a retinoblastoma with enucleation.Which discharge instruction is most important based on the diagnosis?

A)Encouraging healthy eating
B)Irrigation of the surgical site
C)Monitoring the child's temperature
D)Pain assessment and control

Question 21

A child has cancer,is unresponsive,and is doing poorly.Which action by the nursing student causes the faculty to intervene?

A)Allows the parents to hold the child
B)Places the child on NPO status
C)Takes the child's rectal temperature
D)Turns the child even if she moans

Question 22

A child has been cured of a retinoblastoma.When the parents ask how long monitoring for bone-related complications of radiation therapy should continue,which is the most appropriate response by the nurse?

A)"After 5 years,you can stop worrying about this."
B)"Cancers of the bone can occur up to 15 years later."
C)"Probably all complications will occur within 3 years."
D)"Radiation complications do not occur in bones."

Question 23

A parent confides to the nurse that a friend,who is 32,has been diagnosed with Hodgkin's disease.The parent says "I thought only children get that!" What response by the nurse is the most appropriate?

A)"No,there are both young adult and older adult forms."
B)"Usually people over the age of 50 do not get this."
C)"Yes,only children under the age of 10 are affected."
D)"You are right;your friend must have misspoken."

Question 24

A child has liver cancer.The most recent results for the alpha-fetoprotein level show it has been reduced by 50%.Which statement by the nurse to the parents and child is most appropriate at this time?

A)"Once the level gets to normal,we can resect the tumor."
B)"This shows the cancer is responding to therapy."
C)"Unfortunately,the chemotherapy is not working."
D)"Your child will need a liver transplant soon."

Question 25

A child is receiving chemotherapy.The nurse assesses the child's oral cavity and notes the following: raspy voice,thick saliva,and debris on the teeth.Which action by the nurse is the most appropriate?

A)Have the child use commercial mouthwash.
B)Hold the next dose of chemotherapy.
C)Increase the frequency of oral care.
D)Place the child on NPO status.

Question 26

A nurse is preparing to administer chemotherapy to a child who has an Infuse-a-Port.Which action by the nurse is the most appropriate?

A)Flush the catheter with normal saline and heparin.
B)Obtain a Huber needle prior to administration.
C)Unclamp the catheter prior to flushing the line.
D)Wrap the catheter in gauze so it doesn't pull out.

Question 27

A child has nausea after chemotherapy despite anti-emetics.However,the child complains that "my tummy is growling." Which other action should the nurse take to promote comfort for this child?

A)Avoid hard,difficult-to-chew foods.
B)Encourage a high fluid intake with meals.
C)Offer the child hard candy to suck on.
D)Provide bland items,such as plain mashed potatoes.

Question 28

A child needs surgery to resect a tumor,but is scheduled for several weeks of radiation therapy first.The parents are frustrated and want to know why the surgery that can cure the cancer is being delayed.Which response by the nurse is the most appropriate?

A)"Children who have radiation first generally do better than others."
B)"If the radiation destroys the tumor,surgery will not be needed."
C)"Radiation will shrink the tumor,making it easier to get all of it out."
D)"The surgeons must be worried that they cannot get the whole tumor."

Question 29

A nurse caring for a child receiving chemotherapy notes that the child's urine specific gravity is 1.010.Which action by the nurse is the most appropriate?

A)Document the findings in the child's chart.
B)Increase the rate of the IV fluids per protocol.
C)Notify the provider about the laboratory results.
D)Prepare to administer an alkalizing agent.

Question 30

A child is in the hospital receiving chemotherapy for Hodgkin's lymphoma.What action by a new nurse causes the precepting nurse to intervene?

A)Assesses the need for anti-emetics prior to starting chemotherapy
B)Checks the IV for blood return before giving the chemotherapy
C)Double wraps the chemotherapy bags and places in the trash can
D)Performs hand hygiene prior to and after caring for the patient

Question 31

A child has the following laboratory values: WBC,7.2 mm³;bands,4%;and neutrophils,60%.Based on these values,which action by the nurse is the most appropriate?

A)Continue monitoring the child for infection.
B)Place the child on protective isolation.
C)Obtain two sets of blood cultures.
D)Restrict visitors to the child.

Question 32

A student nurse wants to provide nonpharmacological pain management interventions to a hospitalized child with cancer.Which action by the student causes the faculty member to intervene?

A)Applying a moist heat pack
B)Giving the child a massage
C)Reading the child a story
D)Using candles for aromatherapy

Question 33

A nurse works on a pediatric oncology unit.After receiving report,which child should the nurse assess first?

A)Having infusion of D5 $1 / 4$ NS and sodium bicarbonate
B)On high-dose methotrexate (Rheumatrex),urine pH of 7.8
C)Receiving cyclophosphamide (Cytoxan),urine specific gravity of 1.008
D)2 days post-tumor resection,complaining of pain

Question 34

A nurse is caring for four patients who have Hodgkin's lymphoma.Which child should the nurse see first?

A)Anorexia for a week
B)Enlarged cervical lymph nodes
C)Fever of 102.1°F (38.9°C)
D)Mediastinal mass

Question 35

A nurse assesses a toddler using the FLACC score.The child is kicking and crying steadily.The mother is upset,as she is unable to console the child.Which action by the nurse is most appropriate?

A)Administer acetaminophen (Tylenol).
B)Give a dose of morphine (Duramorph).
C)Play soothing,quiet music.
D)Prepare a dose of propofol (Diprovan).

Question 36

Prior to administering IV chemotherapy,which action by the nurse is most important?

A)Ensure the IV has a good blood return.
B)Provide diversionary activities.
C)Take and record a set of vital signs.
D)Weigh the child.

Question 37

A parent brings a 10-year-old child to the clinic,reporting that the child fell while playing and now has a limp several days later.In completing a history,which other finding would the nurse correlate more with bone cancer than a minor trauma?

A)Decreased appetite for the last month
B)Fatigues easily when playing outdoors
C)Limping several weeks prior to the fall
D)Often has unexplained extremity bruises

Question 38

A nurse works on the pediatric oncology floor.After receiving the handoff report,which child does the nurse assess first?

A)Child on protective isolation
B)4 hours post-bone marrow biopsy
C)Not eating an hour after chemotherapy
D)Temperature of 101.5°F (38.5°C)

Question 39

The nurse is completing an admission assessment on a 3-year-old child.The child's Humpty Dumpty score is 15.Which action by the nurse is the most appropriate?

A)Allow the child access to the play room.
B)Classify the child as at high risk for falls.
C)Place the child on seizure precautions.
D)Put the child in isolation precautions.

Question 40

The parents of a child with cancer ask the nurse why the child is losing weight even though he is eating what he normally does.Which response by the nurse is the most appropriate?

A)"Cancer consumes body tissues,causing weight loss."
B)"He may be going through a growth spurt right now."
C)"How do you know he is eating like he normally does?"
D)"When you are sick,you need more nutrition than usual."

Question 41

A pediatric patient is receiving asparaginase (Elspar).What manifestations would lead the nurse to determine that the child is having a possible side effect from this drug? (Select all that apply.)

A)Blistering at infusion site
B)Increased PT and INR
C)Potassium of 2.7 mEq/L
D)Seizures
E)Shortness of breath

Question 42

The nurse is teaching a community group about early warning signs of cancer.Which signs does the nurse include? (Select all that apply.)

A)A sore that does not heal
B)Change in bowel or bladder habits
C)Difficulty swallowing or indigestion
D)Nagging feeling that something is wrong
E)Unusual bleeding or discharge

Question 43

A student nurse is preparing to administer odansetron (Zofran)to a child receiving chemotherapy.The child weighs 44 lb (20 kg).Which actions by the student nurse require intervention by the faculty? (Select all that apply.)

A)Assesses the child's pain with a pediatric scale
B)Discusses side effects with the parents/child
C)Draws up 300 mg for IV administration
D)Prepares to administer 3 mg IV push
E)Withdraws a 200-mg suppository for use

Question 44

A nurse is explaining radiation side effects to the parents of a child for whom it has been ordered.Which side effects does the nurse include in the explanation? (Select all that apply.)

A)Hair loss
B)Leukocytosis
C)Nausea
D)Polycythemia
E)Skin desquamation

Question 45

A child has been admitted with a paraspinal Ewing's sarcoma.The nursing instructor questions the student about assessing for signs of spinal cord compression.Which manifestations does this include? (Select all that apply.)

A)Burning pain down the legs
B)Difficulty with swallowing
C)"Foot drop," causing a limp
D)Respiratory depression
E)Weakness in the hands

Question 46

The nurse is teaching parents about the importance of good nutrition for their child who has cancer.Which components does the nurse include as important for this child's diet? (Select all that apply.)

A)High calories
B)High carbohydrates
C)High vitamins
D)Low minerals
E)Low protein

Question 47

A child is being admitted with an infratentorial brain tumor.Which anatomical regions of the brain does the nurse know this tumor might include? (Select all that apply.)

A)Brainstem
B)Cerebellum
C)Cerebrum
D)Frontal lobe
E)Parietal lobe

Question 48

A student is learning about the process of hematopoiesis and how it is affected by leukemia.Which information does the student discover? (Select all that apply.)

A)Blast cells multiply faster than mature cells.
B)Leukemia disrupts normal hematopoiesis.
C)Lymphoid cells differentiate into B and T cells.
D)Myeloid cells crowd out normal cells in bone marrow.
E)Pancytopenia occurs from proliferation of mast cells.

Question 49

The student nurse studying childhood cancers understands that neoplasms are caused by which factors? (Select all that apply.)

A)Chromosomal/genetic abnormalities
B)External stimuli or environment
C)Maternal nutrition during gestation
D)Substance abuse during pregnancy
E)Viruses that alter the immune system

Question 50

The staff nurse is educating nursing students on the long-term effects of childhood chemotherapy.Which problems does the nurse include in the educational session? (Select all that apply.)

A)Cardiac dysfunction
B)Hearing loss
C)Increased risk of multiple-gestation pregnancies
D)Learning disabilities
E)Peripheral neuropathy

Question 51

The nurse is explaining types of solid tumors to a group of students.Which information does the nurse include? (Select all that apply.)

A)A sarcoma is found in bone or muscle.
B)"Carcinoma" means any cancerous tumor.
C)Epithelial cells give rise to carcinomas.
D)Lymphoma might originate in the thymus.
E)Pediatric and adult solid tumors are similar.

Question 52

A child is getting induction therapy for Burkitt lymphoma.The nurse finds the child lethargic and complaining of side and back pain.The child's morning laboratory results indicate a serum calcium level of 7.2 mg/dL.What actions by the nurse are the most appropriate at this time? (Select all that apply.)

A)Administer a dose of pain medication.
B)Assess Chvostek and Trousseau signs.
C)Call the rapid response team.
D)Encourage an increased oral intake.
E)Prepare to administer allopurinol (Aloprim).

Question 53

The nurse working with pediatric oncology patients educates the patients and families regarding best long-term follow-up practices.Which recommendations does this include? (Select all that apply.)

A)Continued care by an interdisciplinary team
B)Height measurements until puberty is reached
C)Genetic testing prior to having children
D)Risk-based follow-up appointments
E)Thyroid screening for 5 years after remission

Question 54

A nurse is caring for several patients with acute lymphocytic leukemia (ALL).Which children does the nurse understand have the best prognosis?

A)Infant
B)< 10 years of age
C)> 25% abnormal cells in bone marrow aspirate
D)White count 4,200/mm3
E)White count 25,000/mm3

Question 55

A nurse has a RN preceptor student working on the pediatric oncology unit.When teaching the student about oncological crises,what disorders does the nurse include? (Select all that apply.)

A)Inferior vena cava infarction
B)Neurogenic shock
C)Perirectal abscess
D)Pleural effusion
E)Superior vena cava syndrome