Question 1

A child is 2 hours postoperative after a resection of a brain tumor.Which assessment by the nurse takes priority?

Accepted Answer

All actions are appropriate for a child postoperatively.However,the answer that is most specific to this child's procedure is the neurological exam.

Question 2

A nurse hears that a new admission to the hospital was recently diagnosed with the most common kind of childhood cancer.Which collaborative care does the nurse prepare to provide to this patient?

Accepted Answer

The most common type of childhood cancer is acute lymphocytic leukemia (ALL).First-line treatment for ALL is inducing remission with chemotherapy.Antibiotics are not used unless the child has an infection.Bone marrow transplant may be considered later in the child's course of care.A liver transplant would not be a treatment for ALL.

Question 3

A 7-year-old child presents to the emergency department,where the parent reports a 3-week history of pale skin,extreme fatigue,and dizziness.Which laboratory value would the nurse correlate with the patient's current condition?

Accepted Answer

For a child of this age,a normal RBC count is 4-5.2/mm³.Low RBCs can lead to pallor,fatigue,headaches,and dizziness,as tissues are not being oxygenated.The other laboratory values are normal.

Question 4

A child is being discharged after surgical resection of a retinoblastoma with enucleation.Which discharge instruction is most important based on the diagnosis?

Accepted Answer

After enucleation (removal of the eye),the eye socket must be irrigated and a thin layer of antibiotic ointment applied.The other options are valid for all postoperative pediatric patients.

Question 5

A nurse is caring for a child who is scheduled to have intrathecal chemotherapy today.Which action by the nurse is most important when providing care to this patient and family?

Accepted Answer

Intrathecal chemotherapy (introducing chemotherapy into the subarachnoid space of the spinal cord)is an invasive procedure and requires a signed consent.Although all actions are important for this child,the priority is ensuring the consent is executed appropriately and on the chart.

Question 6

A nurse is caring for a child who has acute lymphocytic leukemia and has been treated with doxorubicin (Adriamycin).Which assessment finding would the nurse report immediately?

Accepted Answer

Doxorubicin and other anthracycline drugs are known to cause heart damage.Peripheral edema may signal heart failure and should be reported right away.Loss of appetite and low WBC count are common findings for a child on chemotherapy.A single temperature of 100.6°F does not need to be reported.

Question 7

An 8-year-old child has been diagnosed with a brain tumor.Based on knowledge of childhood cancers,which intervention does the nurse plan to implement when the child is admitted to the hospital?

Accepted Answer

Brain tumors in children 1 to 10 years of age are usually infratentorial and involve the brainstem and cerebellum.Manifestations of brainstem tumors result from involvement of the cranial nerves and include hemiparesis,spastic gait,and frequent stumbling and falling.The nurse implements safety precautions for this child.The other precautions may or may not be needed depending on the child's specific condition,treatment,and side effects of treatment.

Question 8

A nurse is reviewing a patient's chart and notes that the patient has a cancerous tumor that has invaded other organs.Based on this information,at which stage is this patient's cancer classified?

Accepted Answer

A stage IV cancer is one that has invaded other organs.Stage 0 is early cancer,present only in the cells in which it began.Stages I-III are more extensive,with larger tumors and spread to nearby lymph nodes or adjacent organs.

Question 9

A parent brings a child to the clinic and reports that the child is reluctant to walk and has a new limp.The parent also reports that the child seems lethargic and tired all the time.The nurse notes that the child appears pale.Which other finding would warrant immediate notification of the health-care provider?

Accepted Answer

This child has some manifestations of acute lymphocytic leukemia (ALL).Left-sided abdominal enlargement could be indicative of splenomegaly,which is another manifestation of this disease.The nurse should report these findings immediately.Difficulty staying asleep at night is vague and could be related to a number of causes,both physical and behavioral.Polydipsia and polyphagia are two of the three classic signs of diabetes.Swelling of the legs and feet is not a manifestation of ALL.

Question 10

A 4-year-old child is several days postoperative after a resection of a brain tumor.The nurse finds the child irritable and lethargic,and notes that she has vomited.Which medication does the nurse anticipate administering?

Accepted Answer

This child has manifestations of increased intracranial pressure,a possible outcome after brain surgery.The nurse prepares to administer a corticosteroid to decrease the edema.Fosphenytoin and phenytoin are for seizures.Odansetron is for nausea.

Question 11

A nursing student is caring for a child diagnosed with Wilms' tumor.Which action by the student causes the faculty member to intervene?

Accepted Answer

Wilms' tumor is a solid,encapsulated mass that can rupture with palpation.Once the child is diagnosed with this cancer,palpation of the child's abdomen is prohibited.The other actions are appropriate.

Question 12

A nursing faculty member explains to the class that which item is the most important for tumor cell growth?

Accepted Answer

All cells,including tumor cells,need a consistent supply of oxygen and nutrients,delivered via the capillaries.Neoplastic cells must be in close enough proximity to a capillary to provide these required elements.The other factors do not have such an important role,if any,in neoplastic growth.

Question 13

A nursing student asks the faculty member to explain an oncogene.Which response by the faculty member is the most appropriate?

Accepted Answer

An oncogene is a gene found inside a virus that has the ability to encourage a normal cell to become malignant.

Question 14

A clinic nurse notes that a child brought in for a physical has swelling and bruising around the eyes.The patient denies any trauma and the parent reports no environmental allergies.Which assessment is most important?

Accepted Answer

Swelling and bruising around the face and eyes is often seen in children with neuroblastoma.Most commonly the tumor can be found by palpation of the abdomen or neck,where the tumor will present as a hard,painless mass that crosses the midline.

Question 15

A nurse notes in a patient's medical record high levels of vanillymandelic acid (VMA).Based on this information,which condition does the nurse prepare to educate the patient and family about?

Accepted Answer

VMA and homovanillic acid (HVA)are tests used to measure the level of catecholamine metabolites in the urine.Neuroblastomas typically secrete catecholamines,so high levels of either substance are indicative of neuroblastoma.

Question 16

A nurse sees the term "proptosis" in a child's medical record.Which physical assessment does the nurse plan to incorporate into the child's exam based on this finding?

Accepted Answer

Proptosis is a downward displacement of the eyeball that can affect visual acuity and is frequently seen in children with rhabdomyosarcoma.The other assessments are not related.

Question 17

A child is admitted and is scheduled to receive intravenous asparginase (Elspar).Which action by the nurse is most important when administering this medication?

Accepted Answer

Anaphylaxis is a possible side effect of this drug.Emergency medications should be readily available.Ototoxicity can be caused by carboplatin (Paraplatin).Monitoring intake and output is important for any child on IV therapy.Anti-emetic drugs are important for any child receiving chemotherapy.

Question 18

A neutropenic child is admitted to the hospital and placed in protective isolation.Which instruction does the nurse give the family to help maintain a safe environment for the child?

Accepted Answer

The neutropenic child should not have fresh flowers,plants,fruits,or vegetables because they can harbor infectious microorganisms.The other instructions are not needed.

Question 19

A nurse is looking at photographs of a friend's infant.The nurse notes a whitish glow in the child's eyes,and the friend asks why the baby's eyes look so odd.Which response by the nurse is the most appropriate?

Accepted Answer

Leukocoria (also known as the cat's-eye reflex)is a whitish glow in the pupil,often noticed on photographs,and is seen in children with retinoblastoma.The child needs to be seen by his health-care provider.The mother should not wait 6 months.Advising the mother to find out what's wrong with his eyes is not as accurate as explaining the manifestation.This sign is not seen in brain tumors.

Question 20

A child has been diagnosed with chronic myelogenous leukemia (CML).Which statement by the nurse to the parents is most appropriate?

Accepted Answer

The preferred treatment for CML is a bone marrow or stem cell transplant from a matching sibling,which can be curative in up to 80% of patients.Radiation therapy is not used.Although there are many good medications for nausea,this statement is not the best choice,because it is not specific to this child's condition.

Quiz 33: Caring for the Child With Cancer