Deck 29: The Child With Cancer

Question 1

A child has cancer and has been treated with chemotherapy. The most recent lab value indicates that the white blood cell count is very low. Based on this result, which would the nurse expect to administer?

A)Epoetin alfa (Epogen)
B)Ondansetron (Zofran)
C)Oprelvekin (Neumega)
D)Filgrastim (Neupogen)

Answer 1

Filgrastim (Neupogen)

Question 2

The child is receiving chemotherapy for acute lymphocytic leukemia. The nurse recognizes that a potential oncological emergency for this child would be tumor lysis syndrome. For which symptoms should the nurse monitor this child?

A)Respiratory distress and cyanosis
B)Thrombocytopenia and leukocytosis
C)Oliguria and altered levels of consciousness
D)Upper-extremity edema and neck vein distension

Answer 2

Oliguria and altered levels of consciousness

Question 3

An adolescent is receiving methotrexate chemotherapy after undergoing limb-salvage surgery for osteogenic sarcoma. The nurse knows the teen understands what to expect for the schedule of administration for leucovorin therapy if the teen says:

A)"I don't have any pain, so I won't need to take the leucovorin this time."
B)"I don't have any nausea, so I won't need the leucovorin."
C)"I'm glad I only need one dose of the leucovorin."
D)"It is important that I receive my leucovorin on time as it protects my body from the methotrexate."

Answer 3

"It is important that I receive my leucovorin on time as it protects my body from the methotrexate."

Question 4

A five-year-old child is on chemotherapy for rhabdomyosarcoma. Despite antiemetics, the child complains of nausea. The mother wants the child to eat and is pushing the child to eat the food. The nurse would talk with the mother and suggest that she not push the food on the nauseated child because:

A)The child does not need to eat as he is on intravenous fluids.
B)Forcing the child to eat may lead to a food aversion for the child.
C)Vomiting can lead to damage to the stomach.
D)Pushing the child to eat leads to a psychological conflict that may turn the child away from the parent.

Question 5

A child with leukemia has a granulocyte count of 250/mm³ and a platelet count 150,000/mm³. Nursing intervention would include which of the following?

A)Fluid restriction
B)Avoidance of mouth care
C)Strict isolation
D)Good hand washing

Question 6

A child has been diagnosed with a Wilms' tumor and is being treated with chemotherapy. Prior to administering the chemotherapy, what will the nurse monitor to determine if the child has any capability of fighting infection?

A)Hemoglobin
B)Red blood cell count
C)Platelets
D)Absolute neutrophil count (ANC)

Question 7

The parent of a child newly diagnosed with cancer verbalizes regret to the nurse for not seeking earlier medical attention for the child's symptoms. Which response would be most therapeutic?

A)"You may feel guilty, but you should not blame yourself."
B)"Most cancers can be treated easily."
C)"Many types of cancer are difficult to diagnose and might not show early symptoms."
D)"Early diagnosis is not significant in the diagnosis and management of cancer."

Question 8

The antiemetic drug ondansetron (Zofran) is being administered to a child receiving chemotherapy. It should be administered:

A)Only if the child experiences nausea.
B)Before chemotherapy administration, as a prophylactic measure.
C)After the chemotherapy has been administered.
D)Never; this antiemetic is not effective for controlling nausea and vomiting associated with chemotherapy.

Question 9

A child has thrombocytopenia secondary to chemotherapy treatments. Based on this finding, what should the nurse do?

A)Avoid administering intramuscular injections (IM).
B)Monitor intake and output.
C)Use palpation as a component of assessment.
D)Avoid performing oral hygiene.

Question 10

During rounds, the interdisciplinary team is discussing the care of a child with a newly diagnosed Wilms' tumor. The nurse describes the mother as being angry and upset that they are not caring properly for her child. What behavior probably is the cause of the mother's anger?

A)The mother is beginning the stages of grief over loss of her previously well child.
B)The mother is feeling guilty for not recognizing that the child was ill.
C)The nurses are negligent in providing safe care for the child.
D)The mother does not have adequate support from Social Services.

Question 11

The nurse works in an oncology clinic. A preschool-age child is being seen in the clinic, and the nurse anticipates a diagnosis of cancer. The nurse prepares for which of the common reactions preschool-age children have following illnesses and hospitalizations?

A)Unawareness of the illness and its severity
B)Acceptance, especially if able to discuss the disease with children their own age
C)Understanding of what cancer is and how it is treated
D)Thoughts that they caused their illness and are being punished

Question 12

A child has recently been diagnosed with leukemia. The child's sibling is expressing feelings of anger and guilt. This reaction by the sibling is:

A)Abnormal; the sibling should be referred to a psychologist.
B)Unexpected; the cancer is easily treated.
C)Unusual; the illness doesn't affect the sibling.
D)Normal; the sibling is affected, too, and anger and guilt are expected feelings.

Question 13

A child with rhabdomyosarcoma is to undergo radiation therapy after surgical removal of the tumor. The parents should be taught to:

A)Apply lotion to the area before radiation therapy.
B)Apply sunscreen to the area when the child is exposed to sunlight.
C)Remove any markings left after each radiation treatment.
D)Vigorously scrub the area when bathing the child.

Question 14

The child has been admitted to the hospital unit newly diagnosed with retinoblastoma. What would the nurse expect to see when examining the child's eye?

A)A white reflex
B)Blue-tinged sclera
C)A red reflex
D)Yellow sclera

Question 15

The ten-year-old child was diagnosed with a medulloblastoma; following surgery the child is started on chemotherapy by intrathecal injection. While preparing the family for the start of chemotherapy, the nurse will explain that intrathecal administration was chosen because:

A)It reduces side effects.
B)It does not require the child being "stuck."
C)Many chemotherapy drugs do not cross the blood-brain barrier.
D)Intrathecal administration is less expensive than intravenous administration.

Question 16

After years of treatment with chemotherapy and radiation, a child with a brain tumor is shown to be refractory to treatment, and a DNR (Do Not Resuscitate) has been obtained. The mother has reached the stage of acceptance; the father is angry that the medical and nursing team has not been able to "save" his child. How would the multidisciplinary team best support this family?

A)Tell the father that he should have brought his child in earlier for treatment.
B)Continue to include the family in planning care and assure them that the child will be kept comfortable in the days to come.
C)Initiate a Social Services referral.
D)Contact the on-call chaplain for consultation with the entire family and ask him to take the father aside for additional assistance.

Question 17

The nurse is explaining to the mother that her child with cancer will receive chemotherapy daily for one month and then no treatments for six weeks. Following the period of rest, chemotherapy will be administered again for another month. The mother asks why the child can't receive the medication for two months straight. The nurse would explain that the rest period:

A)Prevents the child from having side effects from the drugs.
B)Is due to the scheduling requirements of the infusion center.
C)Is necessary because receiving the medication for more than one month can cause heart failure.
D)Allows normal cells to repair themselves while the cancer cells die.

Question 18

Following diagnosis of osteosarcoma, a 14-year-old girl has a below-the-knee amputation. The girl has had trouble accepting the reality of her amputation. Which behavior, when observed by the nurse, indicates she is beginning to accept the amputation?

A)The girl complains of pain in the missing leg.
B)When physical therapy comes, she is willing to have her temporary prosthetic applied and attempts crutch training.
C)Prior to visiting hours, she asks to be helped to a wheelchair with a blanket over her legs.
D)When the nurses change the dressing on the stump, she watches the dressing change.

Question 19

A child has been diagnosed with Ewing sarcoma and is being started on a chemotherapy protocol. The mother questions the nurse on why more than one drug is being used as it would seem that using fewer drugs would decrease the side effects. The best response by the nurse would include the information that:

A)The child's cancer is a severe form and needs additional drugs to remove the cancer.
B)A protocol is a proven means of treatment.
C)A protocol is used in children but not adults due to the chemotherapy's effect on growth.
D)A protocol involves a group of drugs that work in different modes and have different side effects.

Question 20

The 10-year-old boy is admitted to the pediatric neurologic unit with a suspected craniopharyngioma. The nurse will assess the child with which symptoms related to this brain tumor? Standard Text: Select all that apply.

A)Evening nausea
B)Excessive urination leading to dehydration
C)Nystagmus
D)Headaches
E)Orbital ecchymosis

Question 21

Following diagnosis of Ewing's sarcoma, the physician orders chemotherapy for the 12-year-old child. After discussion with the physician, the parents refuse a central line so the chemotherapy will be administered by peripheral line. The nurse will prevent extravasation by: Standard Text: Select all that apply.

A)Ensuring that the intravenous line is a free flowing line.
B)Administering the medication by infusion pump.
C)Checking for blood return before and during chemotherapy administration.
D)Diluting the medication with normal saline.
E)Administering the vesicant drug last.