Deck 25: The Child with Cancer

Question 1

Which is most descriptive of the pathophysiology of leukemia?

A) Increased blood viscosity occurs.
B) Thrombocytopenia (excessive destruction of platelets) occurs.
C) Unrestricted proliferation of immature white blood cells (WBCs) occurs.
D) First stage of coagulation process is abnormally stimulated.

Answer 1

Unrestricted proliferation of immature white blood cells (WBCs) occurs.

Question 2

The nurse is preparing a child for possible alopecia from chemotherapy. Which should be included?

A) Explain to child that hair usually regrows in 1 year.
B) Advise child to expose head to sunlight to minimize alopecia.
C) Explain to child that wearing a hat or scarf is preferable to wearing a wig.
D) Explain to child that when hair regrows, it may have a slightly different color or texture.

Answer 2

Explain to child that when hair regrows, it may have a slightly different color or texture.

Question 3

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

A) Bone grafting
B) Bone marrow injection
C) IV infusion
D) Intra-abdominal infusion

Answer 3

IV infusion

Question 4

A 5-year-old boy is being prepared for surgery to remove a brain tumor. Nursing actions should be based on which statement?

A) Removal of tumor will stop the various 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 5

The school nurse is discussing testicular self-examination with adolescent boys. Why is this important?

A) Epididymitis is common during adolescence.
B) Asymptomatic sexually transmitted diseases may be present.
C) Testicular tumors during adolescence are generally malignant.
D) Testicular tumors, although usually benign, are common during adolescence.

Question 6

Which 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, rubella, mumps

Question 7

Which is a common clinical manifestation of Hodgkin disease?

A) Petechiae
B) Bone and joint pain
C) Painful, enlarged lymph nodes
D) Enlarged, firm, nontender lymph nodes

Question 8

Which is the usual presenting symptom for testicular cancer?

A) Hard, painful mass
B) Hard, painless mass
C) Epididymis easily palpated
D) Scrotal swelling and pain

Question 9

The nurse is teaching nursing students about childhood nervous system tumors. Which best describes a neuroblastoma?

A) Diagnosis is usually made after metastasis occurs.
B) Early diagnosis is usually possible because of the obvious clinical manifestations.
C) It is the most common brain tumor in young children.
D) It is the most common benign tumor in young children.

Question 10

A young boy will receive a bone marrow transplant (BMT). This is possible because one of his older siblings is a histocompatible donor. Which is this type of BMT called?

A) Syngeneic
B) Allogeneic
C) Monoclonal
D) Autologous

Question 11

Which is the most effective pain-management approach for a child who is having a bone marrow aspiration?

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

Question 12

What is the most common clinical manifestation(s) of brain tumors in children?

A) Irritability
B) Seizures
C) Headaches and vomiting
D) Fever and poor fine motor control

Question 13

A boy with leukemia screams whenever he needs to be turned or moved. Which is the most probable cause of this pain?

A) Edema
B) Bone involvement
C) Petechial hemorrhages
D) Changes within the muscles

Question 14

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

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

Question 15

Myelosuppression, associated with chemotherapeutic agents or some malignancies such as leukemia, can cause bleeding tendencies because of a(n):

A) decrease in leukocytes.
B) increase in lymphocytes.
C) vitamin C deficiency.
D) decrease in blood platelets.

Question 16

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

A) Encourage drinking large amounts of favorite fluids.
B) Encourage child to take nothing by mouth (remain NPO) until nausea and vomiting subside.
C) Administer an antiemetic before chemotherapy begins.
D) Administer an antiemetic as soon as child has nausea.

Question 17

The nurse is admitting a child with a Wilms tumor. Which is the initial assessment finding associated with this tumor?

A) Abdominal swelling
B) Weight gain
C) Hypotension
D) Increased urinary output

Question 18

A young child with leukemia has anorexia and severe stomatitis. The nurse should suggest that the parents try which intervention?

A) Relax any eating pressures.
B) Firmly insist that child eat normally.
C) Begin gavage feedings to supplement diet.
D) Serve foods that are either hot or cold.

Question 19

Which is often administered to prevent or control hemorrhage in a child with cancer?

A) Nitrosoureas
B) Platelets
C) Whole blood
D) Corticosteroids

Question 20

A child with leukemia is receiving triple intrathecal chemotherapy consisting of methotrexate, cytarabine, and hydrocortisone. What will the triple intrathecal chemotherapy prevent?

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

Question 21

When communicating with other professionals, it is important for home care nurses to:

A) ask others what they want to know.
B) share everything known about the family.
C) restrict communication to clinically relevant information.
D) recognize that confidentiality is not possible.

Question 22

The nurse is caring for an adolescent with osteosarcoma being admitted to undergo chemotherapy. The adolescent had a right above-the-knee amputation 2 months ago and has been experiencing "phantom limb pain." Which prescribed medication is appropriate to administer to relieve phantom limb pain?

A) Amitriptyline (Elavil)
B) Hydrocodone (Vicodin)
C) Oxycodone (OxyContin)
D) Alprazolam (Xanax)

Question 23

The treatment of brain tumors in children consists of which therapies? (Select all that apply.)

A) Surgery
B) Bone marrow transplantation
C) Chemotherapy
D) Stem cell transplantation
E) Radiation
F) Myelography

Question 24

A nurse is conducting a staff in-service on childhood cancers. Which is the primary site of osteosarcoma?

A) Femur
B) Humerus
C) Pelvis
D) Tibia

Question 25

One of the supervisors for a home health agency asks the nurse to give the family a survey evaluating the nurses and other service providers. The nurse should recognize this as:

A) inappropriate, unless nurses are able to evaluate family.
B) appropriate to improve quality of care.
C) inappropriate, unless nurses and other providers agree to participate.
D) inappropriate, because family lacks knowledge necessary to evaluate professionals.

Question 26

The home care nurse has been visiting an adolescent with recently acquired tetraplegia. The teen's mother tells the nurse, "I'm sick of providing all the care while my husband does whatever he wants to, whenever he wants to do it." Which should be the initial action of the nurse?

A) Refer mother for counseling.
B) Listen and reflect mother's feelings.
C) Ask father, in private, why he does not help.
D) Suggest ways the mother can get her husband to help.

Question 27

The nurse is monitoring a 7-year-old child post surgical resection of an infratentorial brain tumor. Which vital sign findings indicate Cushing's triad?

A) Increased temperature, tachycardia, tachypnea
B) Decreased temperature, bradycardia, bradypnea
C) Bradycardia, hypertension, irregular respirations
D) Bradycardia, hypotension, tachypnea

Question 28

The home health nurse asks a child's mother many questions as part of the assessment. The mother answers many questions and then stops and says, "I don't know why you ask me all this. Who gets to know this information?" The nurse should take which action?

A) Determine why the mother is so suspicious.
B) Determine what the mother does not want to tell.
C) Explain who will have access to the information.
D) Explain that everything is confidential and that no one else will know what is said.

Question 29

The home health nurse is caring for a child who requires complex care. The family expresses frustration related to obtaining accurate information about their child's illness and its management. Which is the best action for the nurse?

A) Determine why family is easily frustrated.
B) Refer family to child's primary care practitioner.
C) Clarify family's request, and provide information they want.
D) Answer only questions that family needs to know about.

Question 30

A clinic nurse is conducting a staff in-service for other clinic nurses about signs and symptoms of a rhabdomyosarcoma tumor. Which should be included in the teaching session? (Select all that apply.)

A) Bone fractures
B) Abdominal mass
C) Sore throat and ear pain
D) Headache
E) Ecchymosis of conjunctiva

Question 31

A toddler with leukemia is on intravenous chemotherapy treatments. The toddler's lab results are WBC: 1000; neutrophils: 7%; nonsegmented neutrophils (bands): 7%. What is this child's absolute neutrophil count (ANC)? (Record your answer in a whole number.)

Question 32

The nurse is preparing to give oral care to a school-age child with mucositis secondary to chemotherapy administered to treat leukemia. Which preparations should the nurse use for oral care on this child? (Select all that apply.)

A) Chlorhexidine gluconate (Peridex)
B) Lemon glycerin swabs
C) Antifungal troches (lozenges)
D) Lip balm (Aquaphor)
E) Hydrogen peroxide

Question 33

A family wants to begin oral feeding of their 4-year-old son, who is ventilator-dependent and currently tube-fed. They ask the home health nurse to feed him the baby food orally. The nurse recognizes a high risk of aspiration and an already compromised respiratory status. The most appropriate nursing action is to:

A) refuse to feed him orally because the risk is too high.
B) explain the risks involved, and then let the family decide what should be done.
C) feed him orally because the family has the right to make this decision for their child.
D) acknowledge their request, explain the risks, and explore with the family the available options.

Question 34

Home care is being considered for a young child who is ventilator-dependent. Which factor is most important in deciding whether home care is appropriate?

A) Level of parents' education
B) Presence of two parents in the home
C) Preparation and training of family
D) Family's ability to assume all health care costs

Question 35

A mother of a 5-year-old child, with complex health care needs and cared for at home, expresses anxiety about attending a kindergarten graduation exercise of a neighbor's child. The mother says, "I wish it could be my child graduating from kindergarten." The nurse recognizes that the mother is experiencing:

A) abnormal anxiety.
B) ineffective coping.
C) chronic sorrow.
D) denial.

Question 36

Which expected appearance will the nurse explain to parents of an infant returning from surgery after an enucleation was performed to treat retinoblastoma? (Select all that apply.)

A) A lot of drainage will come from the affected socket.
B) The face may be edematous or ecchymotic.
C) The eyelids will be sutured shut for the first week.
D) There will be an eye pad dressing taped over the surgical site.
E) The implanted sphere is covered with conjunctiva and resembles the lining of the mouth.

Question 37

In which position should the nurse place a 10-year-old child after a large tumor was removed through a supratentorial craniotomy?

A) On the inoperative side with the bed flat
B) On the inoperative side with the head of bed elevated 20 to 30 degrees
C) On the operative side with the bed flat and pillows behind the head
D) On the operative side with the head of bed elevated 45 degrees

Question 38

An adolescent with osteosarcoma is scheduled for a leg amputation in 2 days. The nurse's approach should include which action?

A) Answering questions with straightforward honesty
B) Avoiding discussing the seriousness of the condition
C) Explaining that, although the amputation is difficult, it will cure the cancer
D) Assisting the adolescent in accepting the amputation as better than a long course of chemotherapy

Question 39

The nurse is taking care of an adolescent with osteosarcoma. The parents ask the nurse about treatment. The nurse should make which accurate response about treatment for osteosarcoma?

A) Treatment usually consists of surgery and chemotherapy.
B) Amputation of the affected extremity is rarely necessary.
C) Intensive irradiation is the primary treatment.
D) Bone marrow transplantation offers the best chance of long-term survival.

Question 40

A ventilator-dependent child is cared for at home by his parents. Nurses come for 4 hours each day giving the parents some relief. Which other strategy should the nurse recommend to give the parents a break from the responsibilities of caring for a ventilator-dependent child?

A) Encourage members from the parent's church group to provide some relief care.
B) Train a trusted grandparent to provide an occasional break from the responsibilities of care.
C) Encourage the parents to pay out of pocket for additional private duty nurses.
D) Suggest the parents place the child in a care facility.