pediatric success cancer (m15)

31. The nurse is caring for a child with a diagnosis of ALL (Acute Lymphocytic Leukemia) who is receiving chemotherapy. The nurse notes that the child's platelet count is 20,000/mm3. Based on this laboratory finding, what information should the nurse provide to the child and parents? 1. A soft toothbrush should be used for mouth care. 2. Isolation precautions should be started immediately. 3. The child's vital signs, including blood pressure, should be monitored every 4 hours. 4. All visitors should be discouraged from coming to see the family.

1. A soft toothbrush should be used for mouth care. 1. Because the platelet count is decreased, there is a significant risk of bleeding, especially in soft tissue. The use of the soft toothbrush should help prevent bleeding of the gums.

10. The nurse is caring for a child with leukemia. The nurse should be aware that children being treated for leukemia may experience which of the following complications? Select all that apply. 1. Anemia. 2. Infection. 3. Bleeding tendencies. 4. Bone deformities. 5. Polycythemia.

1. Anemia. 2. Infection. . 1. Anemia is caused by decreased production of red blood cells. 2. Infection risk in leukemia is secondary to the neutropenia. 3. Bleeding tendencies are from decreased platelet production. 4. There are no bone deformities with leukemia, but there is bone pain from the proliferation of cells in the bone marrow. 5. Polycythemia is an increase in red blood cells. TEST-TAKING HINT: Review the pathophysiology of leukemia to determine the clinical problems.

51. The parent of a 4-year-old brings the child to the clinic and tells the nurse the child's abdomen is distended. After a complete examination, a diagnosis of Wilms tumor is suspected. Which of the following is most important when doing a physical examination on this child? 1. Avoid palpation of the abdomen. 2. Assess the urine for the presence of blood. 3. Monitor vital signs, especially the blood pressure. 4. Obtain an accurate height and weight.

1. Avoid palpation of the abdomen. 1. Palpating the abdomen of the child in whom a diagnosis of Wilms tumor is suspected should be avoided, because manipulation of the abdomen may cause seeding of the tumor.

49. The parent of a teen with a diagnosis of Hodgkin disease asks what the child's prognosis will be with treatment. What information should the nurse give to the parent and child? 1. Clinical staging of Hodgkin disease will determine the treatment; long-term survival for all stages of Hodgkin disease is excellent. 2. There is a considerably better prognosis if the client is diagnosed early and is between the ages of 5 and 11 years. 3. The prognosis for Hodgkin disease depends on the type of chemotherapy. 4. The only way to obtain a good prognosis is by chemotherapy and bone marrow transplant.

1. Clinical staging of Hodgkin disease will determine the treatment; long-term survival for all stages of Hodgkin disease is excellent. . 1. Long-term survival for all stages of Hodgkin disease is excellent. Earlystage disease can have a survival rate greater than 90%, with advanced stages having rates between 65% and 75%

38. School-age children with cancer often have a body image disturbance related to hair loss, moon face, or debilitation. Which of the following interventions is most appropriate? 1. Encourage them to wear a wig similar to their own hairstyle. 2. Emphasize the benefits of the therapy they are receiving. 3. Have them play only with other children with cancer. 4. Use diversional techniques to avoid discussing changes in the body because of the chemotherapy.

1. Encourage them to wear a wig similar to their own hairstyle. 1. Wearing a wig is a good way for the child to keep personal identity despite the loss of hair.

12. Which of the following measures should the nurse implement to help with the nausea and vomiting from chemotherapy? Select all that apply. 1. Give an antiemetic 30 minutes prior to the start of therapy. 2. Continue the antiemetic as ordered until 24 hours after the chemotherapy is complete. 3. Remove food that has a lot of odor. 4. Keep the child on a nothing-by-mouth status. 5. Wait until the nausea begins to start the antiemetic.

1. Give an antiemetic 30 minutes prior to the start of therapy. 2. Continue the antiemetic as ordered until 24 hours after the chemotherapy is complete. 3. Remove food that has a lot of odor. 1. The first dose should be given 30 minutes prior to the start of the therapy. 2. Antiemetic should be administered around the clock until 24 hours after the chemotherapy is completed. 3. It is also helpful to remove foods with odor so the smell of the food does not make the child nauseated. 4. The child should be allowed to take food and fluids as tolerated. 5. Antiemetics are most beneficial if given before the onset of nausea and vomiting. TEST-TAKING HINT: Review measures to prevent nausea and vomiting.

43. A child diagnosed with leukemia is receiving allopurinol as part of the treatment plan. The parents ask why their child is receiving this medication. What information about the medication should the nurse provide? 1. Helps reduce the uric acid level caused by cell destruction. 2. Used to make the chemotherapy work better. 3. Given to reduce nausea and vomiting associated with chemotherapy. 4. Helps decrease pain in the bone marrow.

1. Helps reduce the uric acid level caused by cell destruction. 1. Allopurinol reduces serum uric acid. When there is lysis of cells from chemotherapy, there will be an increase in serum uric acid.

33. The nurse is caring for a 10-year-old with leukemia who is receiving chemotherapy. The child is on neutropenic precautions. Friends of the child come to the desk and ask for a vase for flowers. Which of the following is the best response? 1. "I will get you a special vase that we use on this unit." 2. "The flowers from your garden are beautiful but should not be placed in the room at this time." 3. "As soon as I can wash a vase, I will put the flowers in it and bring it to the room." 4. "Get rid of the flowers immediately. You could harm the child."

2. "The flowers from your garden are beautiful but should not be placed in the room at this time." 2. A neutropenic client should not have flowers in the room because the flowers may harbor Aspergillus or Pseudomonas aeruginosa. Neutropenic children are susceptible to infection. Precautions need to be taken so the child does not come in contact with any potential sources of infection. Fresh fruits and vegetables can also harbor molds and should be avoided. Telling the friend that the flowers are beautiful but that the child cannot have them is a tactful way not to offend the friend.

11. Which of the following is a (are) reason(s) to do a lumbar puncture on a child with a diagnosis of leukemia? Select all that apply. 1. Rule out meningitis. 2. Assess the central nervous system for infiltration. 3. Give intrathecal chemotherapy. 4. Determine increased intracranial pressure. 5. Stage the leukemia.

2. Assess the central nervous system for infiltration. 3. Give intrathecal chemotherapy. 1. There is no need to do a spinal tap to rule out meningitis unless the patient has symptoms of meningitis. 2. A lumbar puncture is done to assess the central nervous system by obtaining a specimen that can determine the presence of leukemic cells. 3. Chemotherapy can also be given with a spinal tap. 4. There should not be an indication to determine increased intracranial pressure. 5. Leukemia is not staged. TEST-TAKING HINT: Review the central nervous system involvement with leukemia.

46. A child has completed treatment for leukemia and comes to the clinic with the parents for a checkup. The parents express to the nurse that they are glad their child has been cured of cancer and is safe from getting cancer later in life. Which of the following should the nurse consider in responding? 1. Childhood cancer usually instills immunity to all other cancers. 2. Children surviving one cancer are at higher risk for a second cancer. 3. The child may have a remission of the leukemia but is immune to all other cancers. 4. As long as the child continues to take steroids, there will be no other cancers.

2. Children surviving one cancer are at higher risk for a second cancer. 2. The most devastating late effect of leukemia treatment is development of secondary malignancy.

54. What are the clinical manifestations of non-Hodgkin lymphoma? 1. Basically the same as those in Hodgkin disease. 2. Depends on the anatomical site and extent of involvement. 3. Those that affect the abdomen, as non-Hodgkin lymphoma is a fast-growing cancer in very young children. 4. Changes that occur in the lower extremities.

2. Depends on the anatomical site and extent of involvement. 2. The clinical manifestations include symptoms of involvement. Rarely is a single sign or symptom diagnostic. Metastasis to the bone marrow or central nervous system may produce manifestations of leukemia.

41. Which of the following is the best method to prevent the spread of infection to an immunosuppressed child? 1. Administer antibiotics prophylactically to the child. 2. Have people wash their hands prior to contact with the child. 3. Assign the same nurses to care for the child each day. 4. Limit visitors to family members only.

2. Have people wash their hands prior to contact with the child. . 2. Hand-washing is the best method to prevent the spread of germs and protect the child from infection.

55. When caring for a child with lymphoma, the nurse needs to be aware of which of the following? 1. The same staging system is used for lymphoma and Hodgkin disease. 2. The aggressive chemotherapy with central nervous system prophylaxis will give the child a good prognosis. 3. All children with lymphoma need a bone marrow transplant for a good prognosis. 4. Despite high-dose chemotherapy, the prognosis is very poor for most children with a diagnosis of lymphoma.

2. The aggressive chemotherapy with central nervous system prophylaxis will give the child a good prognosis. 2. The use of aggressive combination chemotherapy has a major impact on the survival rates for children with a diagnosis of lymphoma. Because there is usually bone marrow involvement, there is a need for central nervous system prophylaxis.

39. The nurse receives a call from a parent of a child with leukemia in remission. The parent says the child has been exposed to chickenpox. The child has never had chickenpox. Which of the following responses is most appropriate for the nurse? 1. "You need to monitor the child's temperature frequently and call back if the temperature is greater than 101°F (38.3°C)." 2. "At this time there is no need to be concerned." 3. "You need to bring the child to the clinic for a chickenpox immunoglobulin vaccine." 4. "Your child will need to be isolated for the next 2 weeks."

3. "You need to bring the child to the clinic for a chickenpox immunoglobulin vaccine." . 3. The child should receive varicella zoster immune globulin within 96 hours of the exposure.

56. Where is the primary site of origin of the tumor in children who have neuroblastoma? 1. Bone. 2. Kidney. 3. Abdomen. 4. Liver.

3. Abdomen. 3. Neuroblastoma tumors originate from embryonic neural crest cells that normally give rise to the adrenal medulla and the sympathetic nervous system. The majority of the tumors arise from the adrenal gland or from the retroperitoneal sympathetic chain. Therefore, the primary site is within the abdomen.

32. A 5-year-old is admitted to the hospital with complaints of leg pain and fever. On physical examination, the child is pale and has bruising over various areas of the body. The physician suspects that the child has ALL. The nurse informs the parent that the diagnosis will be confirmed by which of the following? 1. Lumbar puncture. 2. White blood cell count. 3. Bone marrow aspirate. 4. Bone scan.

3. Bone marrow aspirate. 3. The diagnostic test that confirms leukemia is microscopic examination of the bone marrow aspirate.

47. A teen is seen in clinic for a possible diagnosis of Hodgkin disease. The nurse is aware that which of the following symptoms should make the physicians suspect Hodgkin disease? 1. Fever, fatigue, and pain in the joints. 2. Anorexia with weight loss. 3. Enlarged, painless, and movable lymph nodes in the cervical area. 4. Enlarged liver with jaundice.

3. Enlarged, painless, and movable lymph nodes in the cervical area. 3. Enlarged, painless, and movable lymph nodes in the cervical area are the most common presenting manifestations of Hodgkin disease.

36. Which of the following should be done to protect the central nervous system from the invasion of malignant cells in a child newly diagnosed with leukemia? 1. Cranial and spinal radiation. 2. Intravenous steroid therapy. 3. Intrathecal chemotherapy. 4. High-dose intravenous chemotherapy.

3. Intrathecal chemotherapy. 3. Giving chemotherapy via lumbar puncture allows the drugs to get to the brain and helps prevent metastasis of the disease.

50. The nurse is caring for a child who is receiving extensive radiation as part of the treatment for Hodgkin disease. Which intervention should be implemented? 1. Administer pain medication prior to the child's going to radiation therapy. 2. Assess the child for neuropathy since this is a common side effect. 3. Provide adequate rest, as the child may experience excessive malaise and lack of energy. 4. Encourage the child to eat a low-protein diet while on radiation therapy.

3. Provide adequate rest, as the child may experience excessive malaise and lack of energy. 3. The most common side effect is extensive malaise, which may be from damage to the thyroid gland, causing hypothyroidism.

52. The parent of a child diagnosed with Wilms tumor asks the nurse what the treatment plan will be. The nurse explains the usual protocol for this condition. Which information should the nurse give to the parent? 1. The child will have chemotherapy and, after that has been completed, radiation. 2. The child will need to have surgery to remove the tumor. 3. The child will go to surgery for removal of the tumor and the kidney and will then start chemotherapy. 4. The child will need radiation and later surgery to remove the tumor.

3. The child will go to surgery for removal of the tumor and the kidney and will then start chemotherapy. 3. Combination therapy of surgery and chemotherapy is the primary therapeutic management. Radiation is done depending on clinical stage and histological pattern.

34. The nurse is discharging a child who has just received chemotherapy for neuroblastoma. Which of the following statements made by the child's parent indicates a need for additional teaching? 1. "I will inspect the skin often for any lesions." 2. "I will do mouth care daily and monitor for any mouth sores." 3. "I will wash my hands before caring for my child." 4. "I will take a rectal temperature daily and report a temperature greater than 101°F (38.3°C) immediately to the physician."

4. "I will take a rectal temperature daily and report a temperature greater than 101°F (38.3°C) immediately to the physician." 4. Monitoring the child's temperature and reporting it to the physician are important, but the temperature should not be taken rectally. The risk of injury to the mucous membranes is high. Rectal abscesses can occur in the damaged rectal tissue. The best method of taking the temperature is axillary, especially if the child has mouth sores. TEST-TAKING HINT: Review home-care instructions for children who have just received chemotherapy. These are measures to protect the child from infection and to monitor for infection.

35. Which intervention should be implemented after a bone marrow aspiration? 1. Ask the child to remain in a supine position. 2. Place the child in an upright position for 4 hours. 3. Keep the child nothing by mouth for 6 hours. 4. Administer analgesics as needed for pain.

4. Administer analgesics as needed for pain. . 4. Children may experience minor discomfort after the procedure, and analgesics should be given as needed. TEST-TAKING HINT: Review the procedure for doing a bone marrow aspiration, and be aware of nursing care after the procedure. There should be no reason for the child to be in a specific position or to have fluids withheld after the procedure. Managing pain is always a priority need.

44. Prednisone is given to children who are being treated for leukemia. Why is this medication given as part of the treatment plan? 1. Enhances protein metabolism. 2. Enhances sodium excretion. 3. Increases absorption of the chemotherapy. 4. Destroys abnormal lymphocytes.

4. Destroys abnormal lymphocytes. . 4. Prednisone is used in many of the treatment protocols for leukemia because there is abnormal lymphocyte production. Prednisone is thought to destroy abnormal lymphocytes. TEST-TAKING HINT: Prednisone is given in conjunction with chemotherapy. It helps modify the body's immune response.

37. A child with leukemia is receiving chemotherapy and is complaining of nausea. The nurse has been giving the scheduled antiemetic. Which of the following should the nurse do when the child is nauseated? 1. Encourage low-protein foods. 2. Encourage low-caloric foods. 3. Offer the child's favorite foods. 4. Offer cool, clear liquids.

4. Offer cool, clear liquids. 4. Cool, clear liquids are better tolerated. Milk-based products cause secretions to be thick and can cause vomiting. TEST-TAKING HINT: With nausea and vomiting, it is important to consider nutritional status. Answers 1 and 2 do not improve nutrition. Supportive nutritional supplements should be offered. Review measures to prevent nausea and provide nutrition.

53. The nurse expects which of the following clinical manifestations in a child diagnosed with SCID? 1. Prolonged bleeding. 2. Failure to thrive. 3. Fatigue and malaise. 4. Susceptibility to infection.

4. Susceptibility to infection. 4. SCID is characterized by an absence of cell-mediated immunity, with the most common clinical manifestation being infection in children from age 3 months. These children do not usually recover from these infections.

13. Which of the following can be manifestations of leukemia in a child? Select all that apply. 1. Leg pain. 2. Fever. 3. Excessive weight gain. 4. Bruising. 5. Enlarged lymph nodes.

1. Leg pain. 2. Fever. 4. Bruising. 5. Enlarged lymph nodes. 1. The proliferation of cells in the bone marrow can cause leg pain. 2. Fever is a result of the neutropenia. 3. There is usually a decrease in weight, because the child will feel sick and not as hungry. 4. A decrease in platelets causes the bruising. 5. The lymph nodes are enlarged from the infiltration of leukemic cells. TEST-TAKING HINT: Review the consequences of depressed bone marrow, and relate them to the clinical manifestations.

48. Which of the following confirms a diagnosis of Hodgkin disease in a 15-year-old? 1. Reed-Sternberg cells in the lymph nodes. 2. Blast cells in the blood. 3. Lymphocytes in the bone marrow. 4. VMA in the urine.

1. Reed-Sternberg cells in the lymph nodes. 1. A lymph node biopsy is done to confirm a histological diagnosis and staging of Hodgkin disease. The presence of Reed-Sternberg cells is characteristic of the disease.

45. Which of the following best describes the action of chemotherapeutic agents used in the treatment of cancer in children? 1. Suppress the function of normal lymphocytes in the immune system. 2. Are alkylating agents and are cell-specific. 3. Cause a replication of DNA and are cell-specific. 4. Interrupt cell cycle, thereby causing cell death.

1. Suppress the function of normal lymphocytes in the immune system. 1. All chemotherapy is immunosuppressive as most childhood cancers affect the immune system.

42. Which of the following is correct regarding prognostic factors for determining survival for a child newly diagnosed with ALL? 1. The initial white blood cell count on diagnosis. 2. The race of the child. 3. The amount of time needed to initiate treatment. 4. The allergy history of the child.

1. The initial white blood cell count on diagnosis. 1. Children with a normal or low white blood cell count who do not have non-T, non-B acute lymphoblastic leukemia, and who are CALLA-positivehave a much better prognosis than those with high cell counts or other cell types.