Question 1

The nurse is caring for a 4-year-old child with acute lymphocytic leukemia (ALL). Why should the nurse assess this child's temperature using the axillary route instead of a rectal temperature?&#10;A) The child has anemia.&#10;B) The child is prone to diarrhea.&#10;C) The child has a low platelet count.&#10;D) The child has a low white blood cell count.

Accepted Answer

Because platelet production is limited in children with leukemia, children are extremely prone to hemorrhage. Gastrointestinal bleeding can occur. An axillary temperature is not taken because the child has anemia, prone to diarrhea, or has a low white blood cell count.

Question 2

A female patient asks the nurse why she is always asked if she is pregnant before having an X-ray. What should the nurse explain to the patient?&#10;A) &#34;Radiation to a fetus can cause a malignancy.&#34;&#10;B) &#34;It is just something that we are expected to do.&#34;&#10;C) &#34;It identifies how much radiation your body can stand.&#34;&#10;D) &#34;It determines how long you can be in the radiation room.&#34;

Accepted Answer

Radiation during intrauterine life is a documented cause of leukemia. Radiation of the thyroid in infancy is known to cause thyroid cancer later in life. Asking a female patient about pregnancy status is not something that a nurse is expected to perform. Asking a female patient about being pregnant is not done to determine how much radiation the body can stand or determine how long the patient can be in the radiation room.

Question 3

The nurses caring for children on an oncology unit are planning an open-house presentation on cancer prevention actions to support the 2020 National Health Goals. Which topics should the nurses include in their presentation? (Select all that apply.)

A) Teaching testicular self-examination
B) The need to take vitamin supplements every day
C) The importance of getting adequate rest and daily exercise
D) Explaining the reasons to avoid excessive sun exposure
E) The importance of frequent health assessments to identify the symptoms of leukemia

Teaching testicular self-examination
Explaining the reasons to avoid excessive sun exposure
The importance of frequent health assessments to identify the symptoms of leukemia

Accepted Answer

Nurses can help the nation achieve the 2020 National Health Goals for cancer prevention in children by careful history taking at health assessments to reveal the symptoms of leukemia and by active teaching of self-screening measures such as testicular examination and preventive measures such as avoiding excessive sun exposure. Vitamin supplementation, rest, and exercise are not identified as actions to prevent cancer in children.

Question 4

A child with leukemia is receiving methotrexate for therapy. Which nursing diagnosis should the nurse use to best guide this patient's care at this time?&#10;A) Impaired oral mucous membrane related to effects of chemotherapy&#10;B) Risk for impaired mobility related to depressant effects of methotrexate&#10;C) Excess fluid volume related to effect of methotrexate on aldosterone secretion&#10;D) Risk for self-directed violence related to effect of methotrexate on central nervous system

Accepted Answer

Mucositis or ulcers of the gum line and mucous membranes of the mouth is a frequent effect of antimetabolic drugs. This is the diagnosis that would have the highest priority for the patient's care at this time. Methotrexate does not impair mobility, impact aldosterone secretion, or cause adverse effects to the central nervous system.

Question 5

A child with leukemia is prescribed to receive ondansetron hydrochloride (Zofran) 0.15 mg/kg intravenously prior to receiving the first dose of chemotherapy. The child weighs 55 lb. How many milligrams of the medication should the nurse provide to the child? (Numeric value only. Calculate to the nearest tenth decimal point.)

Accepted Answer

The nurse needs to first determine the child's weight in kilograms by dividing 55 lb by
2.2 or 55 / 2.2 = 25. Then the nurse should multiply the prescribed dose of 0.15 mg by the child's weight or 0.15 mg × 25 kg = 3.75. After rounding, the nurse should provide the patient with 3.8 mg of the medication prior to receiving chemotherapy.

Question 6

The nurse is preparing the medication leucovorin to provide to a child who is currently receiving methotrexate for a brain tumor. What should the nurse explain to the child and parents regarding the purpose of this medication?

A) It will encourage bone marrow to build new cells after methotrexate therapy.
B) It helps methotrexate enter leukemia cells the same as insulin helps glucose enter cells.
C) It is an experimental drug to ensure resistance to infection during methotrexate therapy.
D) It prevents methotrexate that is not incorporated into leukemia cells from entering normal cells.

Accepted Answer

A drug such as leucovorin, often called leucovorin rescue, may be administered after systemic methotrexate to neutralize its action and protect normal cells from the effect of the drug. Leucovorin is not used to encourage the growth of new cells in the bone marrow. It does not facilitate the use of methotrexate in the cells. Leucovorin is not an experimental drug used to improve resistance to infection.

Question 7

A child being treated for leukemia is diagnosed with neutropenia. What should the nurse instruct the parents and child to prevent infections? (Select all that apply.)&#10;A) Avoid large crowds.&#10;B) Inspect the skin daily for scratches or scrapes.&#10;C) Increase the intake of fresh fruits and vegetables.&#10;D) Remove house plants, flowers, and goldfish from the home environment.&#10;E) Stay away from people who have obvious colds, rashes, or other infections.

Accepted Answer

Strategies to prevent infections in a child with neutropenia include avoiding large crowds; inspecting the skin daily for scratches or scrapes; removing house plants, flowers, and goldfish from the home environment; and staying away from people who have obvious colds, rashes, or other infections. The child's intake of fresh fruits and vegetables should be limited because this could be a source for bacteria.

Question 8

The nurse is concerned that a child receiving vincristine is developing an adverse reaction to the medication. What did the nurse most likely assess in the patient?&#10;A) Tooth pain&#10;B) Numb fingertips&#10;C) Reduced hearing&#10;D) Bright red cheeks

Accepted Answer

The use of vincristine can cause specific neurologic symptoms of weakness, tingling, and numbing of the extremities and sometimes the inability to walk because of loss of ankle support. This medication does not cause tooth pain, reduced hearing, or bright red cheeks.

Question 9

The nurse is planning outcomes for an adolescent male diagnosed with Hodgkin disease. Which outcome should the nurse use to address feelings of powerlessness with the disease?&#10;A) The patient attends recommended appointments.&#10;B) The patient reduces the frequency of extracurricular activities.&#10;C) The patient cuts back the number of hours worked after school.&#10;D) The patient spends time with elderly grandparents and other family members.

Accepted Answer

An outcome that would support feelings of powerlessness would be the patient attends recommended appointments. Reducing extracurricular activities, reducing the number of work hours, and spending time with elderly grandparents and other family members do not support feelings of powerlessness.

Question 10

The mother of a high school football player diagnosed with osteosarcoma of the femur is angry because she did not want him to play football. Which health teaching point should the nurse include in the teaching plan for the patient and mother?

A) Tumor growth is more related to a dislike of milk.
B) Osteosarcoma often follows trauma, such as a football injury.
C) Football injuries do not contribute to the development of a tumor.
D) The patient can expect some discoloration of his leg following chemotherapy.

Accepted Answer

To prevent the adolescent and parents from thinking that the patient caused the tumor, the nurse should explain that trauma did not cause the process. A football injury merely called attention to the leg where a malignant process was at work. Osteosarcoma is not caused by a dislike of milk. There is no expectation of skin color changes when receiving chemotherapy for osteosarcoma.

Question 11

The nurse is completing the health history of a 6-month-old baby with retinoblastoma with the child's parents. Which symptom should the nurse expect that the parents have observed?&#10;A) One pupil appears white.&#10;B) The infant tugs and pulls at one ear.&#10;C) The infant's eye appears to be protruding.&#10;D) The infant always keeps her eyes tightly closed.

Accepted Answer

The answer of The nurse is completing the health history...

Question 12

The nursing is planning care for a child recovering from neck surgery for rhabdomyosarcoma. Which outcome suggests the best long-term prognosis for this patient?&#10;A) The child tolerates chemotherapy to treat the tumor and on the neck and lungs.&#10;B) The child tolerates radiation for neck tumor and tumor found in the colon and liver.&#10;C) The child tolerates chemotherapy provided after complete removal of the neck tumor.&#10;D) The child tolerates chemotherapy every 4 weeks for 24 months to eradicate inoperable tumor.

Accepted Answer

The answer of The nursing is planning care for a...

Question 13

While assessing a school-age child with a brain tumor after morning report, the child has an episode of projectile vomiting. What should the nurse do to help the child?&#10;A) Hold the child's breakfast tray.&#10;B) Administer an antiemetic as prescribed.&#10;C) Provide a cool compress for the forehead.&#10;D) Provide a snack until the breakfast tray arrives.

Accepted Answer

The answer of While assessing a school-age child with a...

Question 14

The nurse is preparing to post a sign above the crib of an infant with a Wilms tumor. Which statement should the nurse post immediately?&#10;A) &#34;Do not palpate abdomen.&#34;&#10;B) &#34;No intramuscular injections.&#34;&#10;C) &#34;No milk or milk products allowed.&#34;&#10;D) &#34;No blood sampling in lower extremities.&#34;

Accepted Answer

The answer of The nurse is preparing to post a...

Question 15

The nurse is preparing to send a child with cancer for a radiation treatment. Which medication should the nurse provide to premedicate the child for this procedure?&#10;A) Analgesic&#10;B) Antiemetic&#10;C) Antipyretic&#10;D) Antineoplastic

Accepted Answer

The answer of The nurse is preparing to send a...

Deck 53: Nursing Care of a Family When a Child or Adolescent Has a Malignancy