Chapter 46: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder

The parents of a child diagnosed with rhabdomyosarcoma ask the nurse to explain what this means. What is the nurse's best response? "There is a tumor in the bone." "There is a tumor in the eye." "The tumor is in the muscle." "This is a tumor of the kidney."

"The tumor is in the muscle."

A child is to receive an oral corticosteroid as part of the treatment regimen for leukemia. After teaching the child and family about this drug, the nurse determines the need for additional teaching when they state: "We will need to gradually decrease the dosage." "He might develop a rounded face from this drug." "We should administer the drug on an empty stomach." "We should check our son's urine for glucose."

"We should administer the drug on an empty stomach."

A 9-year-old child with leukemia is scheduled to undergo an allogeneic hematopoietic stem cell transplant. When teaching the child and parents, what information would the nurse include? "You won't need to receive the high doses of chemotherapy before the transplant." "You'll need to have an incision in your hip area to instill the cells." "The risk for rejection is much less with this type of transplant." "We'll need to have a match to a donor."

"We'll need to have a match to a donor."

Which child is at highest risk for Ewing sarcoma? 4-year-old female whose parents note a mass on the child's abdomen 15-year-old male who reports dull bone pain just below the knee 13-year-old female who reports intermittent pain located in the pelvis 3-year-old male whose parents note a mass on the child's neck

13-year-old female who reports intermittent pain located in the pelvis

The nurse is caring for a 6-year-old boy with an abdominal neuroblastoma prior to having a magnetic resonance imaging (MRI) scan without contrast done. Which intervention would the nurse expect to perform? Applying EMLA to the injection site prior to inserting the IV. Encouraging fluid intake to increase radionuclide uptake. Administering a sedative as ordered to keep the child still. Advising the physician that the child is allergic to shellfish.

Administering a sedative as ordered to keep the child still.

The toddler with a cancer diagnosis is seen for a well-child checkup. Which health maintenance activity will the nurse exclude? Teaching the importance of taking water safety measures Assessing dietary intake by addressing "picky eating" and "food jags" Administering the measles, mumps, rubella (MMR) vaccine Plotting height and weight on a growth chart

Administering the measles, mumps, rubella (MMR) vaccine

A child being treated for leukemia is diagnosed with neutropenia. What nursing instructions directly prevent client infections? Select all that apply. Stay away from people who have obvious colds, rashes, or other infections. Avoid large crowds. Increase the intake of fresh fruits and vegetables. Inspect the skin daily for scratches or scrapes. Remove house plants, flowers, and goldfish from the home environment.

Avoid large crowds. Inspect the skin daily for scratches or scrapes. Remove house plants, flowers, and goldfish from the home environment. Stay away from people who have obvious colds, rashes, or other infections.

The nurse is preparing a discharge teaching plan for the parents of an 8-year-old girl with leukemia. Which instruction would be the priority? Keeping a written copy of the treatment plan Writing down phone numbers and appointments Calling the doctor if the child gets a sore throat Using acetaminophen if the child needs an analgesic

Calling the doctor if the child gets a sore throat

The nurse is assessing an 11-year-old child diagnosed with acute myeloid leukemia (AML) who came to the emergency department. What would alert the nurse to the need for immediate intervention? Observation discloses weight loss and muscle wasting. Palpation reveals lymphadenopathy in the axillae. Complete blood count (CBC) indicates hyperleukocytosis. Child reports a headache and vision problems.

Complete blood count (CBC) indicates hyperleukocytosis.

Which diagnosis would be most appropriate for an infant with a large retinoblastoma after surgery? Disturbed sensory perception related to enucleation Anticipatory grieving related to change in body image Fear related to loss of normal vision Pain related to retinal removal

Disturbed sensory perception related to enucleation

The nurse is caring for a child who had a stem cell transplant and is being monitored for engraftment. Which nursing action is priority? Encourage therapeutic play activities. Remind parents to contact the child's school. Ensure neutropenic precautions are in place. Monitor daily complete blood count (CBC).

Ensure neutropenic precautions are in place.

The pediatric nurse reviews the radiographs of a child and observes that there are lesions on the bone. The nurse interprets this finding as suggesting which condition? Hodgkin disease Ewing sarcoma non-Hodgkin lymphoma neuroblastoma

Ewing sarcoma

A school-aged child with cancer is receiving chemotherapy. Which nursing action would best promote the oral comfort of a child receiving chemotherapy? Encouraging the use of acidic fruit juices to decrease mouth organisms Keeping the child's lips moist with petroleum jelly to prohibit cracking Having the child solely eat or drink cold foods to reduce mucosal pain Vigorously brushing the teeth and gums to remove secretions

Keeping the child's lips moist with petroleum jelly to prohibit cracking

What is a well-defined risk management technique that the nurse can teach children and parents to prevent cancer? Eliminate aerosol sprays from the living area Incorporate more preservative-free foods into the diet Avoid artificial colors, flavors, and fragrances in foods, cosmetics, and household items Limit sun exposure throughout childhood and adolescence

Limit sun exposure throughout childhood and adolescence

A child with acute lymphoblastic leukemia (ALL) is receiving methotrexate for therapy. Which nursing diagnosis would best apply during therapy? Risk for self-directed violence related to effect of methotrexate on central nervous system Risk for impaired skin integrity related to oral ulcerations associated with chemotherapy Excess fluid volume related to effect of methotrexate on aldosterone secretion Risk for impaired mobility related to depressant effects of methotrexate

Risk for impaired skin integrity related to oral ulcerations associated with chemotherapy

Which symptom would lead the nurse to suspect that a child is developing a common side effect of vincristine? The child's hearing seems to be altered. The child says the teeth "ache." The child says the fingertips feel numb. The cheeks are turning bright red.

The child says the fingertips feel numb.

The nurse is preparing clients for diagnostic testing for cancer. Which test is used to differentiate a neuroblastoma from other tumors? Urinalysis Urine catecholamine metabolites, homovanillic acid (HVA), and vanillylmandelic acid (VMA) Serum chemistries Complete blood count (CBC) with differential

Urine catecholamine metabolites, homovanillic acid (HVA), and vanillylmandelic acid (VMA)

The nurse is caring for a child with leukemia. Which nursing intervention would be the highest priority for this child? following guidelines for reverse isolation grouping nursing care providing age-appropriate activities encouraging the child to share feelings

following guidelines for reverse isolation

A school nurse is teaching a group of parents about signs and symptoms of cancer in children. Which symptom is an early sign of a brain tumor? headache, epistaxis, and dizziness nystagmus, ataxia, and seizures headache, vision changes, and vomiting projectile vomiting, lethargy, and coma

headache, vision changes, and vomiting

A child with acute lymphoblastic leukemia (ALL) is starting treatment with methotrexate in an attempt to eradicate the leukemic cells. Which stage of therapy is the child undergoing? consolidation stage sanctuary stage delayed intensive-therapy stage induction stage

induction stage

A child is scheduled for chemotherapy as treatment for leukemia. As the nurse is collaborating with another colleague, the discussion turns to the client's first phase of chemotherapy. This phase is known as: maintenance. induction. delayed intensive therapy. sanctuary.

induction.

Children with acute lymphoblastic leukemia (ALL) may need periodic lumbar punctures. The nurse would teach the parent that this is done to assess for: leukemic cells. platelets. early meningitis. early development of septicemia.

leukemic cells.

When planning the care for a child with leukemia who is receiving methotrexate, the nurse would assess the child closely for which possible effect? weight gain cushingoid facial appearance mucositis paresthesias of the fingers

mucositis

The child has been diagnosed with leukemia. Rank the following medications used to treat leukemia in order based on the stage of treatment. oral steroids and vincristine through an intravenous line chemotherapy through an intrathecal catheter low doses of 6-mercaptopurine and methotrexate high-dose methotrexate and 6-mercaptopurine

oral steroids and vincristine through an intravenous line high-dose methotrexate and 6-mercaptopurine low doses of 6-mercaptopurine and methotrexate chemotherapy through an intrathecal catheter

The nurse is caring for a 6-year-old girl with leukemia who is having an oncologic emergency. Which signs and symptoms would indicate hyperleukocytosis? wheezing and diminished breath sounds bradycardia and distinct S1 and S2 sounds tachycardia and respiratory distress respiratory distress and poor perfusion

tachycardia and respiratory distress

A pediatric nurse is providing a session on risk factors for childhood cancers. Which risk factor does the nurse include in this teaching session? Select all that apply. genetic markers that fail to suppress cancer genetic predisposition for certain cancers viral triggers absence of tumor suppressor cells that allow abnormal growth environmental exposure, such as cigarette smoke accumulation of mutations in the cell that transform to neoplasm

viral triggers genetic predisposition for certain cancers genetic markers that fail to suppress cancer absence of tumor suppressor cells that allow abnormal growth accumulation of mutations in the cell that transform to neoplasm