FINAL 13
A parent tells the nurse that 80% of children with the same type of leukemia as his son's have a 5-year survival. He believes that because another child on the same protocol as his son has just died, his son now has a better chance of success. What is the best response by the nurse?
"Each child has an 80% likelihood of 5-year survival."
The nurse is preparing a school-age child for computed tomography (CT) scan to assess cerebral function. The nurse should include what statement in preparing the child?
"The scan will not hurt."
The nurse is caring for a 6-year-old child with acute lymphoblastic leukemia (ALL). The parent states, "My child has a low platelet count, and we are being discharged this afternoon. What do I need to do at home?" What statement is most appropriate for the nurse to make?
"Your child should avoid contact sports or activities that could cause bleeding."
A child with cancer being treated with chemotherapy is receiving a platelet transfusion. The nurse understands that the transfused platelets should survive the body for how many days?
1 to 3 days
What specific gravity of the urine is desired so that hemorrhagic cystitis is prevented
1.005
The nurse is teaching a parent of an infant to limit the amount of formula to encourage the intake of iron-rich food. What amount should the nurse teach to the parent?
1000 ml
Calculate the absolute neutrophil count (ANC) for the following: WBC count of 5000 mm3; neutrophils (segs) of 10%; and nonsegmented neutrophils (bands) of 12%.
1100/mm3
The clinic nurse is evaluating lab results for a child. What recorded hemoglobin (Hgb) result is considered within the normal range?
12 g/dl
The clinic nurse is evaluating lab results for a child. What recorded hematocrit (Hct) result is considered within the normal range?
40%
Daily toothbrushing and flossing can be encouraged for the child on chemotherapy when the platelet count is above which?
40,000/mm3
The nurse is preparing to administer a unit of packed red blood cells to a hospitalized child. What is an appropriate action that applies to administering blood?
Administer the first 50 ml of blood slowly and stay with the child.
What type of chemotherapeutic agent alters the function of cells by replacing a hydrogen atom of a molecule?
Alkylating agents
An adolescent is scheduled for a leg amputation in 2 days for treatment of osteosarcoma. What approach should the nurse implement
Answer questions with straightforward honesty.
What is a nursing intervention to reduce the risk of increasing intracranial pressure (ICP) in an unconscious child?
Avoid activities that cause pain or crying.
A 5-year-old girl sustained a concussion when she fell out of a tree. In preparation for discharge, the nurse is discussing home care with her mother. What sign or symptom is considered a manifestation of postconcussion syndrome and does not necessitate medical attention?
Behavioral changes
What statement best describes a subdural hematoma?
Bleeding occurs between the dura and the cerebrum.
An injury to which part of the brain will cause a coma?
Brainstem
A child has been diagnosed with a Wilms tumor. What should preoperative nursing care include?
Careful bathing and handling
The nurse is collecting a 24-hour urine sample on a child with suspected diagnosis of neuroblastoma. What finding in the urine is expected with neuroblastomas?
Catecholamines
A child with leukemia is receiving intrathecal chemotherapy to prevent which condition?
Central nervous system (CNS) disease
What are quick, jerky, grossly uncoordinated, irregular movements that may disappear on relaxation called?
Choreiform movements
What pain management approach is most effective for a child who is having a bone marrow test?
Conscious or unconscious sedation
A school-age child has sustained a head injury and multiple fractures after being thrown from a horse. The child's level of consciousness is variable. The parents tell the nurse that they think their child is in pain because of periodic crying and restlessness. What is the most appropriate nursing action?
Consult with a practitioner about what analgesia can be safely administered.
The nurse is caring for a child receiving chemotherapy for leukemia. The child's granulocyte count is 600/mm3 and platelet count is 45,000/mm3. What oral care should the nurse recommend for this child?
Daily toothbrushing and flossing
What chemotherapeutic agent is classified as an antitumor antibiotic?
Daunorubicin (Cerubidine)
A child is receiving vincristine (Oncovin). The nurse should monitor for which side effect of this medication?
Diarrhea
What medication is classified as an antiretroviral?
Didanosine (Videx)
What immunoglobulin pattern does the nurse expect in a child recently diagnosed with Wiskott-Aldrich syndrome?
Diminished levels of IgM
What finding is a clinical manifestation of increased intracranial pressure (ICP) in children?
Diplopia, blurred vision
What is an important priority in dealing with the child suspected of having Wilms tumor?
Ensuring the abdomen is protected from palpation
As part of the diagnostic evaluation of a child with cancer, biopsies are important for staging. What statement explains what staging means?
Extent of the disease at the time of diagnosis
The parents of a child with cancer tell the nurse that a bone marrow transplant (BMT) may be necessary. What information should the nurse recognize as important when discussing this with the family?
Finding a suitable donor involves matching antigens from the human leukocyte antigen (HLA) system.
Postoperative positioning for a child who has had a medulloblastoma brain tumor (infratentorial) removed should be which?
Flat, on either side with pillows behind the back
Nursing strategies to improve the growth and development of the child with human immunodeficiency virus (HIV) infection should include what?
Fortify foods with nutritional supplements to maximize quality of intake.
A child has an absolute neutrophil count (ANC) of 500/mm3. The nurse should expect to be administering which prescribed treatment?
G-CSF (Neupogen) daily
A child with osteosarcoma is experiencing phantom limb pain after an amputation. What prescribed medication is effective for short-term phantom pain relief?
Gabapentin (Neurontin)
A school-age child with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time. What is the most appropriate nursing action to prevent or minimize these reactions with subsequent treatments
Give an antiemetic before chemotherapy begins.
The nurse is preparing a child for possible alopecia from chemotherapy. What information should the nurse include?
Hair may have a slightly different color or texture when it regrows.
A child with hemophilia A is scheduled for surgery. What precautions should the nurse institute with this child?
Handle the child gently when transferring to a cart.
What are the most common clinical manifestations of brain tumors in children?
Headaches and vomiting
A child with sickle cell disease is in a vasoocclusive crisis. What nonpharmacologic pain intervention should the nurse plan?
Heat to the affected area
After chemotherapy is begun for a child with acute leukemia, prophylaxis to prevent acute tumor lysis syndrome includes which therapeutic intervention?
Hydration
An 18-month-old child is brought to the emergency department after being found unconscious in the family pool. What does the nurse identify as the primary problem in drowning incidents?
Hypoxia
The nurse should expect to care for which age of child if the admitting diagnosis is retinoblastoma?
Infant or toddler
An adolescent will receive a bone marrow transplant (BMT). The nurse should explain that the bone marrow will be administered by which method?
Intravenous infusion
What statement is descriptive of a concussion?
It is a transient and reversible neuronal dysfunction.
What chemotherapeutic agent can cause an anaphylactic reaction?
L-Asparaginase (Elspar)
The nurse is assessing a child who was just admitted to the hospital for observation after a head injury. What clinical manifestation is the most essential part of the nursing assessment to detect early signs of a worsening condition?
Level of consciousness
What immunization should not be given to a child receiving chemotherapy for cancer?
Measles, mumps, rubella (MMR)
Essential postoperative nursing management of a child after removal of a brain tumor includes which nursing care?
Measuring all fluid intake and output
Chemotherapeutic agents are classified according to what feature?
Mechanism of action
In teaching parents how to minimize or prevent bleeding episodes when the child is myelosuppressed, the nurse includes what information?
Meticulous mouth care is essential to avoid mucositis.
What nursing intervention is appropriate when caring for an unconscious child?
Monitor fluid intake and output carefully to avoid fluid overload and cerebral edema.
What is appropriate mouth care for a toddler with mucosal ulceration related to chemotherapy?
Mouthwashes with plain saline
One pediatric oncologic emergency is acute tumor lysis syndrome. Symptoms that this may be occurring include what?
Muscle cramps and tetany
The nurse is doing a neurologic assessment on a 2-month-old infant after a car accident. Moro, tonic neck, and withdrawal reflexes are present. How should the nurse interpret these findings?
Neurologic health
The nurse is closely monitoring a child who is unconscious after a fall and notices that the child suddenly has a fixed and dilated pupil. How should the nurse interpret this?
Neurosurgical emergency
What is a common clinical manifestation of Hodgkin disease?
Nontender enlargement of lymph nodes
What term is used to describe a child's level of consciousness when the child is arousable with stimulation?
Obtundation
What test is never performed on a child who is awake?
Oculovestibular response
A child with hemophilia A will have which abnormal laboratory result?
PTT (partial thromboplastin time)
The nurse is caring for a child with hemophilia A. The child's activity is as tolerated. What activity is contraindicated for this child?
Passive range of motion exercises
The nurse is caring for a child with severe head trauma after a car accident. What is an ominous sign that often precedes death?
Periodic or irregular breathing
The nurse is caring for a school-age child with severe anemia and activity intolerance. What diversional activity should the nurse plan for this child?
Playing board or card games
Total-body irradiation is indicated for what reason?
Preparation for bone marrow transplant
In anticipation of the admission of a child with hereditary spherocytosis (HS) who is experiencing an aplastic crisis, what action should the nurse plan?
Prepare for a transfusion of packed red blood cells.
What condition precipitates polycythemia?
Prolonged tissue hypoxia
What rationale explains why prolonged use of oxygen should be discouraged in a child with anemia?
Prolonged use of oxygen can decrease erythropoiesis.
What statement related to clinical trials developed for pediatric cancers is most accurate?
Provide the best available therapy compared with an expected improvement
A young child with leukemia has anorexia and severe stomatitis. What approach should the nurse suggest that the parents try?
Relax any eating pressures.
The mother of an infant tells the nurse that sometimes there is a whitish "glow" in the pupil of his eye. The nurse should suspect which condition?
Retinoblastoma
What childhood cancer may demonstrate patterns of inheritance that suggest a familial basis?
Retinoblastoma
A 10-year-old boy on a bicycle has been hit by a car in front of a school. The school nurse immediately assesses airway, breathing, and circulation. What should be the next nursing action?
Stabilize the child's neck and spine.
The nurse is administering an intravenous chemotherapeutic agent to a child with leukemia. The child suddenly begins to wheeze and have severe urticaria. What nursing action is most appropriate to initiate?
Stop the drug infusion immediately.
What term is used when a patient remains in a deep sleep, responsive only to vigorous and repeated stimulation?
Stupor
What side effect commonly occurs with corticosteroid (prednisone) therapy?
Susceptibility to infection
A parent of a hospitalized child on chemotherapy asks the nurse if a sibling of the hospitalized child should receive the varicella vaccination. The nurse should give which response?
The sibling can get a varicella vaccination.
What description identifies the pathophysiology of leukemia?
Unrestricted proliferation of immature white blood cells (WBCs)
Nursing care of the child with myelosuppression from leukemia or chemotherapeutic agents should include which therapeutic intervention?
Use good hand-washing technique.
A 5-year-old child is being prepared for surgery to remove a brain tumor. Preparation for surgery should be based on which information?
Usually the postoperative dressing covers the entire scalp.
The mother of a 1-month-old infant tells the nurse she worries that her baby will get meningitis like the child's younger brother had when he was an infant. The nurse should base a response on which information?
Vaccinations to prevent pneumococcal and Haemophilus influenzae type B meningitis are available.
A child, age 10 years, has a neuroblastoma and is in the hospital for additional chemotherapy treatments. What laboratory values are most likely this child's?
White blood cell count, 3,000/mm3; hemoglobin, 11.5 g/dl
