Deck 31: The Child With Cancer

Question 1

Nursing care of the child with myelosuppression from leukemia or chemotherapeutic agents should include which therapeutic intervention?

A) Restrict oral fluids.
B) Institute strict isolation.
C) Use good hand-washing technique.
D) Give immunizations appropriate for age.

Answer 1

Use good hand-washing technique.

Question 2

What statement related to clinical trials developed for pediatric cancers is most accurate?

A) Are accessible only in major pediatric centers
B) Do not require consent for standard therapy
C) Provide the best available therapy compared with an expected improvement
D) Are standardized to provide the same treatment to all children with the disease

Answer 2

Provide the best available therapy compared with an expected improvement

Question 3

The nurse is preparing a child for possible alopecia from chemotherapy.What information should the nurse include?

A) Wearing hats or scarves is preferable to a wig.
B) Expose head to sunlight to stimulate hair regrowth.
C) Hair may have a slightly different color or texture when it regrows.
D) Regrowth of hair usually begins 12 months after chemotherapy ends.

Answer 3

Hair may have a slightly different color or texture when it regrows.

Question 4

The nurse is caring for a child receiving chemotherapy for leukemia.The child's granulocyte count is 600/mm³ and platelet count is 45,000/mm³.What oral care should the nurse recommend for this child?

A) Rinsing mouth with water
B) Daily toothbrushing and flossing
C) Lemon glycerin swabs for cleansing
D) Wiping teeth with moistened gauze or Toothettes

Question 5

An adolescent will receive a bone marrow transplant (BMT).The nurse should explain that the bone marrow will be administered by which method?

A) Bone grafting
B) Intravenous infusion
C) Bone marrow injection
D) Intraabdominal infusion

Question 6

After chemotherapy is begun for a child with acute leukemia,prophylaxis to prevent acute tumor lysis syndrome includes which therapeutic intervention?

A) Hydration
B) Oxygenation
C) Corticosteroids
D) Pain management

Question 7

Chemotherapeutic agents are classified according to what feature?

A) Side effects
B) Effectiveness
C) Mechanism of action
D) Route of administration

Question 8

In teaching parents how to minimize or prevent bleeding episodes when the child is myelosuppressed,the nurse includes what information?

A) Meticulous mouth care is essential to avoid mucositis.
B) Rectal temperatures are necessary to monitor for infection.
C) Intramuscular injections are preferred to intravenous ones.
D) Platelet transfusions are given to maintain a count greater than 50,000/mm³.

Question 9

What type of chemotherapeutic agent alters the function of cells by replacing a hydrogen atom of a molecule?

A) Plant alkaloids
B) Antimetabolites
C) Alkylating agents
D) Antitumor antibiotics

Question 10

The nurse is administering an intravenous chemotherapeutic agent to a child with leukemia.The child suddenly begins to wheeze and have severe urticaria.What nursing action is most appropriate to initiate?

A) Recheck the rate of drug infusion.
B) Stop the drug infusion immediately.
C) Observe the child closely for next 10 minutes.
D) Explain to the child that this is an expected side effect.

Question 11

What side effect commonly occurs with corticosteroid (prednisone)therapy?

A) Alopecia
B) Anorexia
C) Nausea and vomiting
D) Susceptibility to infection

Question 12

What immunization should not be given to a child receiving chemotherapy for cancer?

A) Tetanus vaccine
B) Inactivated poliovirus vaccine
C) Diphtheria, pertussis, tetanus (DPT)
D) Measles, mumps, rubella (MMR)

Question 13

The parents of a child with cancer tell the nurse that a bone marrow transplant (BMT)may be necessary.What information should the nurse recognize as important when discussing this with the family?

A) BMT should be done at the time of diagnosis.
B) Parents and siblings of the child have a 25% chance of being a suitable donor.
C) If BMT fails, chemotherapy or radiotherapy will need to be continued.
D) Finding a suitable donor involves matching antigens from the human leukocyte antigen (HLA) system.

Question 14

What chemotherapeutic agent is classified as an antitumor antibiotic?

A) Cisplatin (Platinol AQ)
B) Vincristine (Oncovin)
C) Methotrexate (Texall)
D) Daunorubicin (Cerubidine)

Question 15

Total-body irradiation is indicated for what reason?

A) Palliative care
B) Lymphoma therapy
C) Definitive therapy for leukemia
D) Preparation for bone marrow transplant

Question 16

A school-age child with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time.What is the most appropriate nursing action to prevent or minimize these reactions with subsequent treatments?

A) Administer the chemotherapy between meals.
B) Give an antiemetic before chemotherapy begins.
C) Have the child bring favorite foods for snacks.
D) Keep the child NPO (nothing by mouth) until nausea and vomiting subside.

Question 17

What childhood cancer may demonstrate patterns of inheritance that suggest a familial basis?

A) Leukemia
B) Retinoblastoma
C) Rhabdomyosarcoma
D) Osteogenic sarcoma

Question 18

A young child with leukemia has anorexia and severe stomatitis.What approach should the nurse suggest that the parents try?

A) Relax any eating pressures.
B) Firmly insist that the child eat normally.
C) Serve foods that are either hot or cold.
D) Provide only liquids because chewing is painful.

Question 19

What pain management approach is most effective for a child who is having a bone marrow test?

A) Relaxation techniques
B) Administration of an opioid
C) EMLA cream applied over site
D) Conscious or unconscious sedation

Question 20

As part of the diagnostic evaluation of a child with cancer,biopsies are important for staging.What statement explains what staging means?

A) Extent of the disease at the time of diagnosis
B) Rate normal cells are being replaced by cancer cells
C) Biologic characteristics of the tumor or lymph nodes
D) Abnormal, unrestricted growth of cancer cells producing organ damage

Question 21

An adolescent is scheduled for a leg amputation in 2 days for treatment of osteosarcoma.What approach should the nurse implement?

A) Answer questions with straightforward honesty.
B) Avoid discussing the seriousness of the condition.
C) Explain that although the amputation is difficult, it will cure the cancer.
D) Help the adolescent accept the amputation as better than a long course of chemotherapy.

Question 22

Calculate the absolute neutrophil count (ANC)for the following: WBC count of 5000 mm³; neutrophils (segs)of 10%; and nonsegmented neutrophils (bands)of 12%.

A) 110/mm³
B) 500/mm³
C) 1100/mm³
D) 5000/mm³

Question 23

The mother of an infant tells the nurse that sometimes there is a whitish "glow" in the pupil of his eye.The nurse should suspect which condition?

A) Brain tumor
B) Retinoblastoma
C) Neuroblastoma
D) Rhabdomyosarcoma

Question 24

What is an important priority in dealing with the child suspected of having Wilms tumor?

A) Intervening to minimize bleeding
B) Monitoring temperature for infection
C) Ensuring the abdomen is protected from palpation
D) Teaching parents how to manage the parenteral nutrition

Question 25

One pediatric oncologic emergency is acute tumor lysis syndrome.Symptoms that this may be occurring include what?

A) Muscle cramps and tetany
B) Respiratory distress and cyanosis
C) Thrombocytopenia and sepsis
D) Upper extremity edema and neck vein distension

Question 26

Essential postoperative nursing management of a child after removal of a brain tumor includes which nursing care?

A) Turning and positioning every 2 hours
B) Measuring all fluid intake and output
C) Changing the dressing when it becomes soiled
D) Using maximum lighting to ensure accurate observations

Question 27

What description identifies the pathophysiology of leukemia?

A) Increased blood viscosity
B) Abnormal stimulation of the first stage of coagulation process
C) Unrestricted proliferation of immature white blood cells (WBCs)
D) Thrombocytopenia from an excessive destruction of platelets

Question 28

What are the most common clinical manifestations of brain tumors in children?

A) Headaches and vomiting
B) Blurred vision and ataxia
C) Hydrocephalus and clumsy gait
D) Fever and poor fine motor control

Question 29

A child with leukemia is receiving intrathecal chemotherapy to prevent which condition?

A) Infection
B) Brain tumor
C) Central nervous system (CNS) disease
D) Drug side effects

Question 30

A child,age 10 years,has a neuroblastoma and is in the hospital for additional chemotherapy treatments.What laboratory values are most likely this child's?

A) White blood cell count, 17,000/mm³; hemoglobin, 15 g/dl
B) White blood cell count, 3,000/mm³; hemoglobin, 11.5 g/dl
C) Platelets, 450,000/mm³; hemoglobin, 12 g/dl
D) White blood cell count, 10,000/mm³; platelets, 175,000/mm³

Question 31

A parent tells the nurse that 80% of children with the same type of leukemia as his son's have a 5-year survival.He believes that because another child on the same protocol as his son has just died,his son now has a better chance of success.What is the best response by the nurse?

A) "It is sad for the other family but good news for your child."
B) "Each child has an 80% likelihood of 5-year survival."
C) "The data suggest that 20% of the children in the clinic will die. There are still many hurdles for your son."
D) "You should avoid the grieving family because you will be benefiting from their loss."

Question 32

The nurse is caring for a 6-year-old child with acute lymphoblastic leukemia (ALL).The parent states,"My child has a low platelet count,and we are being discharged this afternoon.What do I need to do at home?" What statement is most appropriate for the nurse to make?

A) "You should give your child aspirin instead of acetaminophen for fever or pain."
B) "Your child should avoid contact sports or activities that could cause bleeding."
C) "You should feed your child a bland, soft, moist diet for the next week."
D) "Your child should avoid large groups of people for the next week."

Question 33

The nurse should expect to care for which age of child if the admitting diagnosis is retinoblastoma?

A) Infant or toddler
B) Preschool- or school-age child
C) School-age or adolescent child
D) Adolescent

Question 34

A child has an absolute neutrophil count (ANC)of 500/mm³.The nurse should expect to be administering which prescribed treatment?

A) Platelets
B) Packed red blood cells
C) Zofran (ondansetron)
D) G-CSF (Neupogen) daily

Question 35

What is appropriate mouth care for a toddler with mucosal ulceration related to chemotherapy?

A) Mouthwashes with plain saline
B) Lemon glycerin swabs for cleansing
C) Mouthwashes with hydrogen peroxide
D) Swish and swallow with viscous lidocaine

Question 36

What specific gravity of the urine is desired so that hemorrhagic cystitis is prevented?

A) 1.035
B) 1.030
C) 1.025
D) 1.005

Question 37

Postoperative positioning for a child who has had a medulloblastoma brain tumor (infratentorial)removed should be which?

A) Trendelenburg
B) Head of bed elevated above heart level
C) Flat on operative side with pillows behind the head
D) Flat, on either side with pillows behind the back

Question 38

A 5-year-old child is being prepared for surgery to remove a brain tumor.Preparation for surgery should be based on which information?

A) Removal of the tumor will stop the various signs and symptoms.
B) Usually the postoperative dressing covers the entire scalp.
C) He is not old enough to be concerned about his head being shaved.
D) He is not old enough to understand the significance of the brain.

Question 39

What is a common clinical manifestation of Hodgkin disease?

A) Petechiae
B) Bone and joint pain
C) Painful, enlarged lymph nodes
D) Nontender enlargement of lymph nodes

Question 40

A child has been diagnosed with a Wilms tumor.What should preoperative nursing care include?

A) Careful bathing and handling
B) Monitoring of behavioral status
C) Maintenance of strict isolation
D) Administration of packed red blood cells

Question 41

A health care provider prescribes ondansetron (Zofran)0.15 mg/kg intravenously (IV)30 minutes before chemotherapy for a child with acute lymphoblastic leukemia.The child weighs 22 kg.The medication label states: "Ondansetron (Zofran)2 mg/1 ml." The nurse prepares to administer the dose.How many milliliters will the nurse prepare to administer the dose? Fill in the blank.Round your answer to one decimal place.
________________

Question 42

The health care provider prescribes vancomycin 200 mg per intravenous piggyback (IVPB)every 6 hours for a child with cancer admitted to the hospital for fever and neutropenia.The pharmacy sends the medication to the unit in a 240-ml bag with directions to run the medication over 120 minutes.What milliliters per hour will the nurse set the intravenous pump to run the medication over 120 minutes? Fill in the blank and record your answer in a whole number.
_____________

Question 43

What are favorable prognostic criteria for acute lymphoblastic leukemia?

A) Male gender
B) CALLA positive
C) Early pre-B cell
D) 2 to 10 years of age
E) Leukocyte count ?7?50,000/mm³

Question 44

What strategies should the nurse implement to increase nutritional intake for the child receiving chemotherapy?

A) Allow the child any food tolerated.
B) Fortify foods with nutritious supplements.
C) Allow the child to be involved in food selection.
D) Encourage the parents to place pressure on the importance of eating.
E) Encourage the child to eat favorite foods during infusion of chemotherapy medications.

Question 45

What guidelines should the nurse follow when handling chemotherapeutic agents?

A) Use clean technique.
B) Prepare medications in a safety cabinet.
C) Wear gloves designed for handling chemotherapy.
D) Wear face and eye protection when splashing is possible.
E) Discard gloves and protective clothing in a special container.

Question 46

A child with cancer being treated with chemotherapy is receiving a platelet transfusion.The nurse understands that the transfused platelets should survive the body for how many days?

A) 1 to 3 days
B) 4 to 6 days
C) 7 to 9 days
D) 10 to 12 days

Question 47

The health care provider prescribes ceftazidime (Fortaz)75 mg per intravenous piggyback (IVPB)every 8 hours for a child with cancer admitted with fever and neutropenia.The pharmacy sends the medication to the unit in a 50-ml bag with directions to run the medication over 30 minutes.What milliliters per hour will the nurse set the intravenous pump to run the medication over 30 minutes? Fill in the blank and record your answer in a whole number.
_____________

Question 48

What chemotherapeutic agent can cause an anaphylactic reaction?

A) Prednisone (Deltasone)
B) Vincristine (Oncovin)
C) L-Asparaginase (Elspar)
D) Methotrexate (Trexall)

Question 49

A child with osteosarcoma is experiencing phantom limb pain after an amputation.What prescribed medication is effective for short-term phantom pain relief?

A) Phenytoin (Dilantin)
B) Gabapentin (Neurontin)
C) Valproic Acid (Depakote)
D) Phenobarbital (Phenobarbital)

Question 50

The nurse is collecting a 24-hour urine sample on a child with suspected diagnosis of neuroblastoma.What finding in the urine is expected with neuroblastomas?

A) Ketones
B) Catecholamines
C) Red blood cells
D) Excessive white blood cells

Question 51

The nurse should teach the family that which residual disabilities can occur for a child being treated for a brain tumor?

A) Ataxia
B) Anorexia
C) Dysphagia
D) Sensory deficits
E) Crania nerve palsies

Question 52

Calculate the absolute neutrophil count for a child with a WBC = 6000/mm³,neutrophils = 18%,and nonsegmented neutrophils (bands)= 20%.Record your answer below in a whole number.
____________

Question 53

The nurse is caring for a child with retinoblastoma that was treated with an enucleation.What interventions should the nurse plan for care of an eye socket after enucleation?

A) Clean the prosthesis.
B) Change the eye pad daily.
C) Keep the opposite eye covered initially.
D) Irrigate the socket daily with a prescribed solution.
E) Apply a prescribed antibiotic ointment after irrigation.

Question 54

Calculate the absolute neutrophil count for a child with a WBC = 3000/mm³,neutrophils = 10%,and nonsegmented neutrophils (bands)= 10%.Record your answer below in a whole number.
_____________

Question 55

Daily toothbrushing and flossing can be encouraged for the child on chemotherapy when the platelet count is above which?

A) 10,000/mm³
B) 20,000/mm³
C) 30,000/mm³
D) 40,000/mm³

Question 56

A health care provider prescribes Osmitrol (mannitol)0.25 g/kg intravenously (IV)every 6 hours for a child after a brain tumor removal.The child weighs 20 kg.The medication label states: "Osmitrol (Mannitol)250 mg/1 ml." The nurse prepares to administer the dose.How many milliliters will the nurse prepare to administer the dose? Fill in the blank.Record your answer in a whole number.
________________

Question 57

A child on chemotherapy has developed rectal ulcers.What interventions should the nurse teach to the child and parents to relieve the discomfort of rectal ulcers?

A) Warm sitz baths
B) Use of stool softeners
C) Record bowel movements
D) Use of an opioid for discomfort
E) Occlusive ointment applied to the area

Question 58

The nurse is precepting a new graduate nurse at an ambulatory pediatric hematology and oncology clinic.What cardinal signs of cancer in children should the nurse make the new nurse aware of?

A) Sudden tendency to bruise easily
B) Transitory, generalized pain
C) Frequent headaches
D) Excessive, rapid weight gain
E) Gradual, steady fever
F) Unexplained loss of energy

Question 59

A parent of a hospitalized child on chemotherapy asks the nurse if a sibling of the hospitalized child should receive the varicella vaccination.The nurse should give which response?

A) The sibling can get a varicella vaccination.
B) The sibling should not get a varicella vaccination.
C) The sibling should wait until the child is finished with chemotherapy.
D) The sibling should get varicella-zoster immune globulin if exposed to chickenpox.

Question 60

A child is receiving vincristine (Oncovin).The nurse should monitor for which side effect of this medication?

A) Diarrhea
B) Photosensitivity
C) Constipation
D) Ototoxicity

Question 61

Calculate the absolute neutrophil count for a child with a WBC = 15,000/mm³,neutrophils = 29%,and nonsegmented neutrophils (bands)= 29%.Record your answer in a whole number.
_____________

Question 62

Calculate the absolute neutrophil count for a child with a WBC = 10,000/mm³,neutrophils = 25%,and nonsegmented neutrophils (bands)= 22%.Record your answer in a whole number.
_____________