Deck 24: The Child With Cancer

Question 1

A child who is diagnosed with leukemia has a sibling who is expressing feelings of anger and guilt. How would the nurse characterize this reaction by the sibling?
1) Abnormal; the sibling should be referred to a psychologist.
2) Normal; the illness doesn't affect the sibling.
3) Unexpected; the cancer is easily treated.
4) Normal; the sibling is affected too, and anger and guilt are expected feelings.

Answer 1

4

Question 2

A child is diagnosed with thrombocytopenia secondary to chemotherapy treatments. Which action by the nurse is the most appropriate?
1) Refrain from administering any intramuscular injections (IM).
2) Perform oral hygiene.
3) Monitor intake and output.
4) Use palpation as a component of assessment.

Answer 2

1

Question 3

An adolescent is receiving methotrexate chemotherapy after undergoing limb-salvage surgery for osteogenic sarcoma. Which statement by the adolescent indicates understanding of the purpose of leucovorin therapy after the methotrexate?
1) "I'm glad I only need one dose of the leucovorin."
2) "I don't have any pain so I won't need to take the leucovorin this time."
3) "I know I will be taking the leucovorin every 6 hours for about the next 3 days."
4) "I don't have any nausea so I won't need the leucovorin."

Answer 3

3

Question 4

A preschool-age child is brought to the clinic by the mother, who says the child has been lethargic and anorexic lately and complains of bone pain. On exam, the nurse notes petechiae, joint pain, and an enlarged liver. Which diagnosis does the nurse anticipate for this child?
1) Hodgkin disease
2) Leukemia
3) Rhabdomyosarcoma
4) Ewing sarcoma

Question 5

A child is diagnosed with rhabdomyosarcoma. Which nursing intervention is most appropriate for this child?
1) Position the child with the head elevated
2) Monitor for hematuria
3) Demonstrate the use of a conformer
4) Administer oxygen

Question 6

A child diagnosed with cancer is prescribed chemotherapy. The latest lab value indicates the WBC count is very low. Which medication order does the nurse anticipate?
1) Filgrastim (Neupogen)
2) Ondansetron (Zofran)
3) Oprelvekin (Neumega)
4) Epoetin alfa (human recombinant erythropoietin)

Question 7

The nurse is teaching a 10-year-old and family about the diagnosis of Ewing sarcoma. The nurse knows that instruction has been successful when the child and family indicate which is a common site?
1) Bone marrow
2) Head
3) Shaft
4) Growth plate
5) Bursae

Question 8

A 24-hour urine collection for vanillylmandelic acid (VMA) has been ordered on a child suspected of having neuroblastoma. When is the most appropriate time for the nurse to begin the collection?
1) At 0700
2) After the next time the child voids
3) At bedtime
4) When the order is noted

Question 9

The pediatric nurse is providing care to a school-age child receiving chemotherapy to treat cancer. Which interventions are appropriate to include in the plan of care in order to monitor for oncologic emergencies? Select all that apply.
1) Monitor complete blood count (CBC).
2) Document intake and output.
3) Observe for behavioral changes.
4) Refer for psychosocial support.
5) Implement neutropenic precautions.

Question 10

The child is admitted to the hospital after being diagnosed with retinoblastoma. Which assessment finding does the nurse anticipate for this child?
1) A red reflex
2) Yellow sclera
3) A white pupil
4) Blue-tinged sclera

Question 11

The antiemetic drug ondansetron (Zofran) is administered to a child receiving chemotherapy. When should the nurse administer this medication?
1) Only if the child experiences nausea
2) After the chemotherapy has been administered
3) Before chemotherapy administration as a prophylactic measure
4) Never; this antiemetic is not effective for controlling nausea and vomiting associated with chemotherapy

Question 12

A preschool child is seen in the clinic, and the nurse anticipates a diagnosis of leukemia. Which reaction does the nurse anticipate this child will exhibit upon diagnosis?
1) Acceptance, especially if able to discuss the disease with children their own age
2) Thoughts that they caused their illness and are being punished
3) Understanding of what cancer is and how it is treated
4) Unawareness of the illness and its severity

Question 13

The nurse is monitoring the urine specific gravity and pH on a child receiving chemotherapy. Which urinalysis result is the goal for this child?
1) Spec gravity 1.030; pH 6
2) Spec gravity 1.030; pH 7.5
3) Spec gravity 1.005; pH 6
4) Spec gravity 1.005; pH 7.5

Question 14

The pediatric nurse educator is conducting an in-service for novice nurses who will begin working on the pediatric oncology unit. The educator wants to include the common clinical manifestations of cancer. Which manifestation will the educator include in the presentation? Select all that apply.
1) Cachexia
2) Anemia
3) Gene abnormalities
4) Palpable mass
5) Chromosomal abnormalities

Question 15

The child has just been diagnosed with osteosarcoma, and the nurse is teaching the family regarding this type of cancer. The nurse knows that instruction has been successful when the family states that osteosarcoma is common in which age group?
1) Infants
2) Toddlers
3) Preschool-age children
4) School-age children
5) Adolescents

Question 16

A child diagnosed with a Wilms tumor is prescribed chemotherapy. Which laboratory test will the nurse monitor prior to administering the chemotherapy to determine the child's infection-fighting capability?
1) Hemoglobin
2) RBC count
3) Absolute neutrophil count (ANC)
4) Platelets

Question 17

A seasoned nurse is precepting a novice nurse on a pediatric oncology unit. The seasoned nurse would like to review the ongoing physiologic and psychosocial care of the children who survive cancer. Which topics will the seasoned nurse include in the discussion with the novice nurse? Select all that apply.
1) Developing other cancers
2) Recommending regular office visits
3) Encouraging school-age clients to manage their own care
4) Needing weekly laboratory tests
5) Providing educational and psychosocial support

Question 18

A child undergoing chemotherapeutic treatment for cancer is being admitted to the hospital for fever of 102 degrees F and possible sepsis. Cultures, antibiotics, and acetaminophen (Tylenol) along with bed rest have been ordered for this child. Place the following steps in order from first to last.
Response 1 Administer the antibiotics.
Response 2 Administer the acetaminophen (Tylenol).
Response 3 Obtain the cultures.
Response 4 Ensure the child has bed rest.

Question 19

A child with a brain tumor is admitted to the pediatric intensive care unit (PICU) after brain surgery to remove the tumor. Which postoperative order would the nurse question?
1) Antibiotics
2) Sodium levels every 24 hours
3) Anticonvulsants
4) Hourly intake and output

Question 20

A child is diagnosed with a Wilms tumor. Which nursing action is most appropriate prior to surgery?
1) Careful bathing and handling
2) Monitoring of behavioral status
3) Maintenance of strict isolation
4) Administration of packed RBCs