Chapter 25: Cancer

A pediatric oncology patient is undergoing chemotherapy. Which observation would lead the nurse to suspect that the patient has developed sterile hemorrhagic cystitis? A. Absence of hematuria B. Presence of proteinuria C. Complaints by the patient that it burns upon urination D. Increased sensation of thirst.

B.

A pediatric oncology patient has been discharged home following a course of chemotherapy. Which information should be included as part of discharge planning with regard to health promotion? A. No further treatments are needed and the patient can resume routine health assessments as developmentally appropriate. B. There are no restrictions based on activity and/or contacts with friends and family members. C. Certain restrictions will be in place related to immunizations that can be administered. D. The patient should limit fluid intake for several months in order to prevent overhydration from occurring.

C.

Administration of colony stimulating agents for the pediatric oncology patient are used to: A.decrease nausea. B. shrink tumor size. C. increase bone marrow response. D. decrease production of stem cells.

C.

Which finding if observed would warrant intervention regarding the administration of an antiemetic in a chemotherapy protocol for a pediatric patient? A.Providing the medication on a scheduled basis regardless of the patient's clinical symptoms. B. Administering the medication via the parenteral route prior to infusion of chemotherapy protocol. C. Providing medication with sips of water following clinical symptoms of nausea and/or vomiting. D.Administering 30 to 60 minutes prior to initiation of therapy.

C.

A pediatric oncology patient has developed a nose bleed. Which finding would account for this occurrence? A. Increased white blood cell count B. Increased neutrophils C. Decreased hemoglobin and hematocrit D. Decreased platelet count

D

A child with lymphoma is receiving extensive radiotherapy. Which of the following is the most common side effect of this treatment? A. Malaise B. Seizures C. Neuropathy D. Lymphadenopathy

A (Malaise is the most common side effect of radiotherapy. For children, the fatigue may be especially distressing because it means they cannot keep up with their peers.)

A child with cancer has the following lab result: WBC 10,000, RBC 5, and plts of 20,000. When planning this child's care, which risk should the nurse consider most significant? A. Hemorrage B. Anemia C. Infection D. Pain

A (The lab values presented all are normal except for the platelet count. Decreases in platelet counts place the child at greatest risk for hemorrhage.)

The mother of a 5-year-old child asks the nurse questions regarding the importance of vigilant use of sunscreen. Which information is most important for the nurse to convey to the mother? a.) Appropriate use of sunscreen decreases the risk of skin cancer. b.) Repeated exposure to the sun causes premature aging of the skin. c.) A child's skin is delicate, and burns easily. d.) In addition to causing skin cancer, repeated sun exposure predisposes the child to other forms of cancer.

A (While all of the answer choices are correct, recommending the use of sunscreen to decrease the incidence of skin cancer (a) is the best response.)

A child is being placed on long-term prednisone therapy as part of the treatment for her leukemia and will be going home on the regimen. What teaching about the steroid treatment should the nurse provide to the parents? Select all that apply. A. Weight gain happens because of increased appetite. B. Frequent urination because of fluid loss. C. Her blood pressure should be monitored. D. Sleep disturbances, such as dreaming, can occur. E. Calm behavioral patterns should be present. F. Facial fullness usually disappears when the prednisone therapy has stopped.

A, C, D, F Weight gain occurs because of increased appetite and salt/fluid retention. Her blood pressure should be monitored because of fluid retention. Sleep disturbances, such as dreaming, can occur. It is true that the facial fullness usually disappears when the prednisone therapy has stopped. It will take a while to resolve, just as it took a while to appear. Fluid retention is common, not fluid loss. Emotional lability (mood changes) is characteristic of this medication. The child can be happy one minute and angry several minutes later without a trigger for the anger.

The nurse is caring for a preschool child after the removal of a brain tumor. What should the nurse include in the child's care? Select all that apply. A. Observe for colorless drainage at the operative site. B. Position the child side-lying in the Trendelenburg position. C. Avoid giving analgesics because of altered consciousness. D. Provide close supervision while the child is regaining consciousness. E. Allow unlimited visitors so that the child does not get lonely.

A, D Colorless drainage may be leakage of cerebrospinal fluid from the incision site. This needs to be reported as soon as possible. The child needs to be observed closely. Careful assessment of the vital signs and monitoring for signs of increasing intracranial pressure need to be done. The child should not be positioned in the Trendelenburg position postoperatively. Analgesics can be used for postoperative pain but generally not opioids. Only parents of the child should visit at designated times to prevent overstimulation and potential for increased intracranial pressure.

The nurse is caring for a child with Wilms tumor. Which preoperative nursing intervention is the most important? A. Avoid palpating the abdomen. B. Closely monitor arterial blood gases. C. Prepare the child and family for long-term dialysis. D. Prepare the child and family for renal transplantation.

A. Avoid palpating the abdomen. Wilms tumors are encapsulated. It is extremely important to avoid any palpation of the mass to minimize the risk of dissemination of cancer cells to adjacent and other sites. Closely monitoring arterial blood gases is not indicated preoperatively for this abdominal surgery. Preparing the child and family for long-term dialysis is not indicated unless both kidneys have to be removed. This option is considered a last resort. If both kidneys are involved, preoperative chemotherapy or radiation are used to minimize the size of the tumor. Renal transplantation is planned if both kidneys need to be removed and a compatible living donor exists. Otherwise, dialysis is necessary until a donor organ can be obtained.

A child with lymphoma is receiving extensive radiation therapy. The nurse should be familiar about the most common side effect of this treatment? A. Fatigue B. Seizures C. Neuropathy D. Lymphadenopathy

A. Fatigue Fatigue is the most common side effect of radiation therapy. For children, the fatigue may be especially distressing, because it means they cannot keep up with their peers. Seizures are unlikely, because cranial irradiation is not usually involved in the treatment of lymphoma. Neuropathy is a side effect of certain chemotherapeutic agents. Lymphadenopathy is one of the findings of lymphoma.

The nurse is preparing to administer chemotherapeutic drugs. Which statement would most govern how the nurse administers the drugs? A. Many chemotherapeutic agents are vesicants that can cause severe cellular damage if the drug infiltrates. B. Good handwashing is essential when handling chemotherapeutic drugs, but gloves are not necessary. C. Infiltration will not occur unless superficial veins are used for the intravenous infusion. D. Anaphylaxis cannot occur because the drugs are considered toxic to normal cells.

A. Many chemotherapeutic agents are vesicants that can cause severe cellular damage if the drug infiltrates. Chemotherapeutic agents can be extremely damaging to cells. Nurses experienced with the administration of vesicant drugs should be responsible for giving these drugs and be prepared to treat extravasation if necessary. Gloves are worn to protect the nurse when handling the drugs, and the hands should be thoroughly washed both before and afterward. Infiltration and extravasation are always a risk, especially with peripheral veins. Anaphylaxis is a possibility with some chemotherapeutic and immunologic agents.

A child with newly diagnosed leukemia has been admitted for the initial round of chemotherapy. What common signs and symptoms of leukemia related to bone marrow involvement would the nurse expect to find either in the child's history or during the assessment? A. Petechiae, infection, and fatigue B. Headache, papilledema, and irritability C. Muscle wasting, weight loss, and fatigue D. Decreased intracranial pressure, psychosis, and confusion

A. Petechiae, infection, and fatigue These are signs of infiltration of the bone marrow: petechiae from lowered platelet count, infection from the decreased number of effective leukocytes, and fatigue from the anemia. Headache, papilledema, and irritability are not signs of bone marrow involvement. Muscle wasting, weight loss, and fatigue are not signs of bone marrow involvement. Decreased intracranial pressure, psychosis, and confusion are not signs of bone marrow involvement.

The mother of a child receiving chemotherapy asks about the term, "nadir." Which explanation by the nurse is best? A. The nadir is the time of the greatest bone marrow suppression, when blood counts will be the lowest. B. The nadir occurs when the blood counts have returned to their pre-chemotherapy values. C. The nadir occurs 2 to 3 days after chemotherapy administration when the blood counts begin to drop. D. The nadir describes the first few hours after chemotherapy administration has finished.

A. The nadir is the time of the greatest bone marrow suppression, when blood counts will be the lowest.

Which nursing intervention should not be included in the postoperative plan of care for a child undergoing surgery for a brain tumor? a. Place the child in Trendelenburg position. b. Perform neurologic assessments. c. Assess dressings for drainage. d. Monitor temperature.

ANS: A Feedback A The child is never placed in the Trendelenburg position because it increases intracranial pressure and the risk of bleeding. B Increased intracranial pressure is a risk in the postoperative period. The nurse would assess the child's neurologic status frequently. C Hemorrhage is a risk in the postoperative period. The child's dressing would be inspected frequently for bleeding. D Temperature is monitored closely because the child is at risk for infection in the postoperative period.

The nurse notes that a child's gums bleed easily and he has bruising and petechiae on his extremities. What laboratory values are consistent with these symptoms? a. Platelet count of 19,000/mm3 b. Prothrombin time of 11 to 15 seconds c. Hematocrit of 34 d. Leukocyte count of 14,000/mm3

ANS: A Feedback A The normal platelet count is 150,000 to 400,000/mm3. This finding is very low, indicating an increased bleeding potential. The child should be monitored closely for signs of bleeding. B The prothrombin time of 11 to 15 seconds is within normal limits. C The normal hematocrit is 35 to 45 and, although this finding is low, it would not create the symptoms presented. D This value indicates the probable presence of infection, but it is not a reflection of bleeding tendency.

What should the nurse recognize as symptoms of a brain tumor in a school-age child for whom she is caring? (Select all that apply.) a. Blurred vision b. Increased head circumference c. Vomiting when getting out of bed d. Intermittent headache e. Declining academic performance

ANS: A, C, D, E Feedback Correct Visual changes such as nystagmus, diplopia, and strabismus are manifestations of a brain tumor. The change in position on awakening causes an increase in intracranial pressure, which is manifested as vomiting. Vomiting on awakening is considered a hallmark symptom of a brain tumor. Increased intracranial pressure resulting from a brain tumor is manifested as a headache. School-age children may exhibit declining academic performance, fatigue, personality changes, and symptoms of vague, intermittent headache. Other symptoms may include seizures or focal neurologic deficits. Incorrect Manifestations of brain tumors vary with tumor location and the child's age and development. Infants with brain tumors may have increased head circumference with a bulging fontanel. School-age children have closed fontanels and therefore their head circumferences do not increase with brain tumors.

The pediatric nurse understands that the most common cancer found in children is: A. Non-hodgkin's lymphoma B. Acute lymphocytic leukemia C. Chronic lymphocytic leukemia D. Ewing's sarcoma"

B (1. No - this is not a common cancer in children 2. YES! this is the most common form of cancer found in children is acute lymphocytic leukemia. 3. No - this is not a common cancer in children 4. No - this is not a common cancer in children)

A child with a brain tumor is undergoing radiation therapy. What should the nurse include in the discharge instructions to the child's parents? (Select all that apply.) a. Apply over-the-counter creams to the area daily. b. Avoid excessive skin exposure to the sun. c. Use a washcloth when cleaning the area receiving radiation. d. Plan for adequate rest periods for the child. e. A darkening of the skin receiving radiation is expected.

ANS: B, D, E Feedback Correct: Children receiving cranial radiation are particularly affected by fatigue and an increased need for sleep during and shortly after completion of the course of radiation. Skin damage can include changes in pigmentation (darkening), redness, peeling, and increased sensitivity. Incorrect: Extra care must be taken to avoid excessive skin exposure to heat, sunlight, friction (such as rubbing with a towel or washcloth), and creams or moisturizers. Only topical creams and moisturizers prescribed by the radiation oncologist should be applied to the radiated skin.

A nurse determines that parents understood the teaching from the pediatric oncologist if the parents indicate that which test confirms the diagnosis of leukemia in children? a. Complete blood cell count (CBC) b. Lumbar puncture c. Bone marrow biopsy d. Computed tomography (CT) scan

ANS: C Feedback A A CBC may show blast cells that would raise suspicion of leukemia. It is not a confirming diagnostic study. B A lumbar puncture is done to check for central nervous system involvement in the child who has been diagnosed with leukemia. C The confirming test for leukemia is microscopic examination of bone marrow obtained by bone marrow aspiration and biopsy. D A CT scan may be done to check for bone involvement in the child with leukemia. It does not confirm a diagnosis.

Which statement, if made by a nurse to the parents of a child with leukemia, indicates an understanding of teaching related to home care associated with the disease? a. "Your son's blood pressure must be taken daily while he is on chemotherapy." b. "Limit your son's fluid intake just in case he has central nervous system involvement." c. "Your son must receive all of his immunizations in a timely manner." d. "Your son's temperature should be taken frequently."

ANS: D Feedback A The child's temperature must be taken daily because of the risk for infection, but it is not necessary to take a blood pressure daily. B Fluid is never withheld as a precaution against increased intracranial pressure. If a child had confirmed CNS involvement with increased intracranial pressure, this intervention might be more appropriate. C Children who are immunosuppressed should not receive any live virus vaccines. D An elevated temperature may be the only sign of an infection in an immunosuppressed child. Parents should be instructed to monitor their child's temperature as often as necessary.

A pediatric patient has been diagnosed with leukemia and presents with a white blood cell (WBC) count of 80,000 mm3. Which statement if provided by a nursing student indicates that additional teaching is needed with regard to pathophysiological mechanisms of leukemia? A. The increase in WBC provides protection against bacterial infections. B. Although the WBC count is elevated, there are increased blast cells which help to protect the patient against infection. C. The amount of white blood cells is greatly increased, which affords protection against viral infections. D. Increases in white blood cells are expected but associated with a low leukocyte count.

B.

A 9-year old child with leukemia is in remission and has returned to school. The school nurse calls the mother of the child and tells the mother that a classmate has just been diagnosed with chickenpox. The mother immediately calls the clinic nurse because the leukemic child has never had chickenpox. The appropriate response by the clinic nurse to the mother is: A. There is no need to be concerned. B. Bring the child into the clinic for a vaccine. C. Keep the child out of school for 2 week period. D. Monitor the child for an elevated temperature, and call the clinic if this happens.

B. Bring the child into the clinic for a vaccine. (Rationale: immunocompromised children are unable to fight varicella adequately. Chickenpox can be deadly to the them. If the child who has not had chickenpox is exposed to someone with varicella, the child should receive varicella zoster immune globulin within 96hrs of exposure. Options 1,3,4, are incorrect because they do nothing to minimize the chances of developing the disease.)

A preschool-aged child is to undergo several painful procedures. Which of the following techniques is most-appropriate for the nurse to use in preparing the child? A. Allow the child to practice injections on a favorite doll. B. Explain the procedure in simple terms. C. Allow a family member to explain the procedure to the child. D. Allow the child to watch an educational video.

B. Explain the procedure in simple terms. (Preschoolers have the cognitive ability to understand simple terms. Use of a favorite doll is contraindicated because it is ""part"" of that child and he/she might perceive the doll is experiencing pain.)

A 15-year-old has been admitted to the hospital with the diagnosis of acute lymphocytic leukemia. Which of the following signs and symptoms require the most immediate nursing intervention? A. Fatigue and Anorexia B. Fever and Petechiae C. Swollen lymph nodes in the neck and lethargy. D. Enlarged liver and spleen

B. Fever and Petechiae (Fever and petechiae associated with acute lymphocytic leukemia indicate a suppression of normal white blood cells and thrombocytes by the bone marrow and put the client at risk for other infections and bleeding. The nurse should initiate infection control and safety precautions to reduce these risks. Fatigue is a common symptom of leukemia due to red blood cell suppression. Although the client should be told about the need for rest and meal planning, such teaching is not the priority intervention. Swollen glands and lethargy may be uncomfortable but they do not require immediate intervention. An enlarged liver and spleen do require safety precautions that prevent injury to the abdomen; however, these precautions are not the priority.)

The nurse is caring for a child with myelosuppression from chemotherapeutic agents. What activities should the nurse include while giving care? A. Restriction of oral fluids B. Performing good hand hygiene C. Instituting strict isolation D. Giving immunizations appropriate for age

B. Performing good hand hygiene Good hand hygiene is the most effective means of preventing disease transmission. Strict isolation is not necessary. The child should not receive any live vaccines. The immune system is not capable of responding appropriately to the vaccine. There is no indication that fluids should be reduced.

A child is admitted to the hospital with a diagnosis of Wilm's tumor, Stage II. Which of the following statements most accurately describes this stage? A. The tumor is less than 3 cm. in size and requires no chemotherapy. B. The tumor did not extend beyond the kidney and was completely resected. C. The tumor extended beyond the kidney but was completely resected. D. The tumor has spread into the abdominal cavity and cannot be resected.

C (The staging of Wilm's tumor is confirmed at surgery as follows: Stage I, the tumor is limited to the kidney and completely resected; stage II, the tumor extends beyond the kidney but is completely resected; stage III, residual nonhematogenous tumor is confined to the abdomen; stage IV, hematogenous metastasis has occurred with spread beyond the abdomen; and stage V, bilateral renal involvement is present at diagnosis.)

A child being treated for Acute Lymphocytic Leukemia (ALL) has a white blood cell (WBC) count of 7,000/mm3. the nursing care plan lists risk for infection as a priority nursing diagnosis, and measures are being taken to reduce the child's exposure to infection. the nurse determines that the plan has been successful when which outcome has been met? A. child's WBC count goes up. B. child's WBC count goes down. C. child's temperature remains within normal range. D. parents demonstrate good hand washing technique."

C. child's temperature remains within normal range. (In leukemia, the WBCs that are present are immature and incapable of fighting infection. increases or decreases in the number of WBCs can be related to the disease process and treatment, and not related to infection. the only value that indicates the child is infection-free is the temperature. the use of proper handwashing technique is a measure or intervention used to meet a goal. but is not a goal itself. STRATEGY: the core issue of the question is knowledge of an indicator of infection in a client who is immunosuppressed from leukemia. recall that temperature and WBC counts are frequently used as indicators of infection. recall that in leukemia the WBCs are abnormal so choose the option related to temperature.)

You are working with the parents of a pediatric oncology patient who has successfully responded to therapy but is now experiencing body image changes as a result of hair loss due to chemotherapy regimen. The parents are upset about this change in their child's appearance. Which response would be appropriate with regard to the parent's concern? A. As the therapy has been successful, it is important to focus on that rather than body image changes. B. Tell the parents that the child's hair will grow back soon. C. Tell the parents that the child's hair will grow back stronger and healthier. D. Acknowledge the parent's concern and focus on available options that may be used to help with body image concerns.

D

The nurse is completing a care plan for a client diagnosed with leukemia. Which independent problem should be addressed? A. Infection. B. Anemia. C. Nutrition. D. Grieving.

D (Grieving is an independent problem, and the nurse can assess and treat this problem with or without collaboration)

A nurse analyzes the lab values of a child with leukemia who is receiving chemotherapy. The nurse notices that the platelet count is 19,500 cell/mm3. Based on this lab value which intervention would the nurse document in her plan of care. A. Monitor closely for signs of infection. B. Temp every four hours. C. Isolation precautions D. Use a small toothbrush for mouth care"

D (Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production. If the platelet count is les than 20,000 than bleeding precautions need to be taken.)

Chemotherapy dosage is frequently based on total body surFace area (BSA), so it is important for the nurse to do which of the following before administering chemotherapy? A. Measure abdominal girth B. Claculate BMI C. Ask the client about his/her height and weight D. Weigh and measure the client on the day of medication administration

D (To ensure that the client receives optimal doses of chemotherapy, dosing is usually based on the total Body surface area(BSA) which requires accurate height and weight before each med administration. Simply asking the client about height/weight may lead to inaccuracies in determining BSA. Calculating BMI and measuring abdominal girth does not provide the data needed.)

In taking care of a pediatric oncology patient, which diagnostic finding would indicate a critical concern for the development of bleeding? A. Absolute neutrophil count of 1000 mm3 B. Temperature of 99.2° F C. White blood cell count 18,000 mm3 D. Platelet count 50,000 mm3

D.

A 3-year-old child is scheduled for surgery to remove a Wilms tumor from one kidney. The parents ask the nurse about what treatments, if any, will be necessary after recovery from surgery. What would be the most appropriate response from the nurse? A. "Radiation therapy may be necessary." B. "A kidney transplant will be planned." C. "No additional treatments are usually necessary." D. "Chemotherapy with or without radiation therapy is indicated."

D. "Chemotherapy with or without radiation therapy is indicated." This determination will be made on the basis of the histologic pattern of the tumor. Chemotherapy with or without radiation therapy is usually indicated. Radiation therapy may be necessary, but chemotherapy is first. Most children with Wilms tumor do not require renal transplants. Additional therapy is indicated after the tumor is removed.

A 4-year-old has a right nephrectomy to remove a Wilms tumor. The nurse knows that it is essential to: A. Request a low-salt diet B. Restrict fluids C. Educate the family regarding renal transplants D. Prevent urinary tract infections

D. Prevent urinary tract infections (Because the child has only one remaining kidney, it is important to prevent urinary tract infections. Answers A, B, and C are not necessary, so they are incorrect.)

An example of a disease process that is based on a "two-hit" hypothesis leading to a cancer diagnosis is: A. Fanconi anemia. B. Wiskott Aldrich syndrome. C. Klinefelter syndrome. D. Retinoblastoma.

D. Retinoblastoma.

A child is undergoing remission induction therapy to treat leukemia. Allopurinol is included in the regimen. The main reason for administering allopurinol as part of the client's chemotherapy regimen is to: a. Prevent metabolic breakdown of xanthine to uric acid b. Prevent uric acid from precipitating in the ureters c. Enhance the production of uric acid to ensure adequate excretion of urine d. Ensure that the chemotherapy doesn't adversely affect the bone marrow"

a. Prevent metabolic breakdown of xanthine to uric acid (The massive cell destruction resulting from chemotherapy may place the client at risk for developing renal calculi; adding allopurinol decreases this risk by preventing the breakdown of xanthine to uric acid. Allopurinol doesn't act in the manner described in the other options.)

After a client is admitted to the pediatric unit with a diagnosis of acute lymphocytic leukemia, the laboratory test indicates that the client is neutropenic. The nurse should perform which of the following? a. Advise the client to rest and avoid exertion b. Prevent client exposure to infections c. Monitor the blood pressure frequently d. Observe for increased bruising

b. Prevent client exposure to infections (Rationale: Neutropenia is a decreased number of neutrophil cells in the blood which are responsible for the body's defense against infection. Rest and avoid exertion would be related to erythrocytes and oxygen carrying properties. Monitoring the blood pressure, and observing for bruising would be related to platelets and sign and symptoms of bleeding.)

The nurse should base a response to a parent's question about the prognosis of acute leukemia (ALL) on the knowledge that: a. Leukemia is a fatal disease, although chemotherapy provides increasingly longer periods of remission. b. Research to find a cure for childhood cancers is very active. c. The majority of children go into remission and remain symptom free when treatment is completed. d. It usually takes several months of chemotherapy to achieve a remission.

c. The majority of children go into remission and remain symptom free when treatment is completed. Feedback A With the majority of children surviving 5 years or longer, it is inappropriate to refer to leukemia as a fatal disease. B This statement is true, but it does not address the parent's concern. C Children diagnosed with the most common form of leukemia, ALL, can almost always achieve remission, with a 5-year disease-free survival rate approaching 85%. D About 95% of children achieve remission within the first month of chemotherapy. If a significant number of blast cells are still present in the bone marrow after a month of chemotherapy, a new and stronger regimen is begun.

A preschool-age child undergoing chemotherapy experiences nausea and vomiting. Which of the following would be the best intervention to include in the child's plan of care? a. Administer tube feedings. b. Offer small, frequent meals. c. Offer fluids only between meals. d. Allow the child to choose what to eat for meals.

d. Allow the child to choose what to eat for meals. (While all options can be done to encourage nutrition, allowing the preschooler choices meets two issues: nutrition and developmental tasks.)