Peds Ch 24

A child diagnosed with cancer is prescribed chemotherapy. The latest lab value indicates the WBC count is very low. Which medication order does the nurse anticipate? 1. Filgrastim (Neupogen) 2. Ondansetron (Zofran) 3. Oprelvekin (Neumega) 4. Epoetin alfa (human recombinant erythropoietin)

Answer: 1 Explanation: 1. Filgrastim (Neupogen) increases production of neutrophils by the bone marrow. Ondansetron (Zofran) is an antiemetic, oprelvekin (Neumega) increases platelets, and epoetin alfa (human recombinant erythropoietin) stimulates RBC production.

A child is diagnosed with rhabdomyosarcoma. Which nursing intervention is most appropriate for this child? 1. Position the child with the head elevated 2. Monitor for hematuria 3. Demonstrate the use of a conformer 4. Administer oxygen

Answer: 1 Explanation: 1. The most common area of the body affected by rhabdomyosarcoma is the bladder. The nursing intervention that is most appropriate is to monitor the child's urine for hematuria. Positioning the child with the head elevated and administering oxygen is appropriate for a child diagnosed with lymphoma. Demonstrating the use of a conformer is appropriate for a child diagnosed with retinoblastoma.

A child is diagnosed with a Wilms tumor. Which nursing action is most appropriate prior to surgery? 1. Careful bathing and handling 2. Monitoring of behavioral status 3. Maintenance of strict isolation 4. Administration of packed RBCs

Answer: 1 Explanation: 1. The tumor should never be palpated; careful bathing and handling are an important nursing consideration. Palpating the tumor can cause a piece of the tumor to dislodge. The child's behavior will not be affected with a Wilms tumor. The tumor does not cause excessive lowering of WBCs or RBCs, so strict isolation or administration of packed RBCs is not usually a nursing intervention.

A child is diagnosed with thrombocytopenia secondary to chemotherapy treatments. Which action by the nurse is the most appropriate? 1. Refrain from administering any intramuscular injections (IM). 2. Perform oral hygiene. 3. Monitor intake and output. 4. Use palpation as a component of assessment.

Answer: 1 Explanation: 1. When the child is thrombocytopenic (decreased platelets) from chemotherapy, the nurse should not administer IM injections because of the risk of bleeding. Oral hygiene care should be done with a soft toothbrush and intake and output monitored for any abnormalities. Gentle palpation should still be included in physical assessments.

The pediatric nurse is providing care to a school-age child receiving chemotherapy to treat cancer. Which interventions are appropriate to include in the plan of care in order to monitor for oncologic emergencies? Select all that apply. 1. Monitor complete blood count (CBC). 2. Document intake and output. 3. Observe for behavioral changes. 4. Refer for psychosocial support. 5. Implement neutropenic precautions.

Answer: 1, 2, 3 Explanation: 1. Oncologic emergencies can be organized into three groups: metabolic, hematologic, and those involving space-occupying lesions. Appropriate interventions for the nurse to include in the plan of care to monitor for these emergencies include monitoring the CBC to prevent sepsis and hemorrhage; monitoring intake and output by encouraging hydration to prevent hypercalcemia and observing for signs of water intoxication; and observing for behavioral changes as space-occupying lesions may cause seizures or increased intracranial pressure. Referring for psychosocial support and implementing neutropenia precautions may be appropriate, but these interventions do not address oncologic emergencies.

The pediatric nurse educator is conducting an in-service for novice nurses who will begin working on the pediatric oncology unit. The educator wants to include the common clinical manifestations of cancer. Which manifestation will the educator include in the presentation? Select all that apply. 1. Cachexia 2. Anemia 3. Gene abnormalities 4. Palpable mass 5. Chromosomal abnormalities

Answer: 1, 2, 4 Explanation: 1. Common clinical manifestations of childhood cancer include cachexia, anemia, and a palpable mass. Gene abnormalities and chromosomal abnormalities are common etiologies to childhood cancer, not clinical manifestations.

A seasoned nurse is precepting a novice nurse on a pediatric oncology unit. The seasoned nurse would like to review the ongoing physiologic and psychosocial care of the children who survive cancer. Which topics will the seasoned nurse include in the discussion with the novice nurse? Select all that apply. 1. Developing other cancers 2. Recommending regular office visits 3. Encouraging school-age clients to manage their own care 4. Needing weekly laboratory tests 5. Providing educational and psychosocial support

Answer: 1, 2, 5 Explanation: 1. Appropriate topics include discussing the increased risk for these children to develop other cancers; recommending regular office visits for monitoring purposes; and providing educational and psychosocial support. It would be appropriate to encourage the adolescent and young adult clients to manage their own care, not a school-age child. While these clients need regular laboratory examinations, weekly laboratory tests are not appropriate.

A 24-hour urine collection for vanillylmandelic acid (VMA) has been ordered on a child suspected of having neuroblastoma. When is the most appropriate time for the nurse to begin the collection? 1. At 0700 2. After the next time the child voids 3. At bedtime 4. When the order is noted

Answer: 2 Explanation: 1. A 24-hour urine collection is started after the child voids. That specimen is not saved, but all subsequent specimens in that 24-hour period should be collected. It would not be an accurate collection of 24 hours of urine if the collection began at 0700, bedtime, or when the order is noted.

A child with a brain tumor is admitted to the pediatric intensive care unit (PICU) after brain surgery to remove the tumor. Which postoperative order would the nurse question? 1. Antibiotics 2. Sodium levels every 24 hours 3. Anticonvulsants 4. Hourly intake and output

Answer: 2 Explanation: 1. Antibiotics, anticonvulsants, and hourly intake and output are appropriate orders. Serum sodium levels should be done every 4 to 6 hours, not every 24 hours.

A preschool-age child is brought to the clinic by the mother, who says the child has been lethargic and anorexic lately and complains of bone pain. On exam, the nurse notes petechiae, joint pain, and an enlarged liver. Which diagnosis does the nurse anticipate for this child? 1. Hodgkin disease 2. Leukemia 3. Rhabdomyosarcoma 4. Ewing sarcoma

Answer: 2 Explanation: 1. Hodgkin disease, rhabdomyosarcoma, and Ewing sarcoma are all childhood cancers, but they do not have the clinical manifestations listed. Leukemia is one of the most common childhood cancers, and has those clinical symptoms.

A preschool child is seen in the clinic, and the nurse anticipates a diagnosis of leukemia. Which reaction does the nurse anticipate this child will exhibit upon diagnosis? 1. Acceptance, especially if able to discuss the disease with children their own age 2. Thoughts that they caused their illness and are being punished 3. Understanding of what cancer is and how it is treated 4. Unawareness of the illness and its severity

Answer: 2 Explanation: 1. Preschool-age children may think they caused their illness. Adolescents find contact with others who have gone through their experience helpful. School-age children can understand a diagnosis of cancer. Infants and toddlers are unaware of the severity of the disease.

A child undergoing chemotherapeutic treatment for cancer is being admitted to the hospital for fever of 102 degrees F and possible sepsis. Cultures, antibiotics, and acetaminophen (Tylenol) along with bed rest have been ordered for this child. Place the following steps in order from first to last. Response 1 - Administer the antibiotics. Response 2 - Administer the acetaminophen (Tylenol). Response 3 - Obtain the cultures. Response 4 - Ensure the child has bed rest.

Answer: 2, 3, 1, 4 Response 2 - Administer the acetaminophen (Tylenol). Response 3 - Obtain the cultures. Response 1 - Administer the antibiotics. Response 4 - Ensure the child has bed rest. Explanation: Give acetaminophen (Tylenol) first to decrease discomfort and reduce fever. Obtain the cultures next because management of infections is critical, and since a child on chemotherapy has lowered immune status, unusual agents can be identified. Cultures can help identify the causative agents before treatment is started. Give the antibiotics next, as an infection can seriously impact the child who is receiving chemotherapy. Finally, provide comfort followed by bed rest to allow the child to rest.

The nurse is teaching a 10-year-old and family about the diagnosis of Ewing sarcoma. The nurse knows that instruction has been successful when the child and family indicate which is a common site? 1. Bone marrow 2. Head 3. Shaft 4. Growth plate 5. Bursae

Answer: 3 Explanation: 1. Ewing sarcoma is a malignant, tumor involving the diaphyseal (shaft) portion of the long bones. Common sites include: femur, pelvis, tibia, fibula, ribs, humerus, scapula, and clavicle.

An adolescent is receiving methotrexate chemotherapy after undergoing limb-salvage surgery for osteogenic sarcoma. Which statement by the adolescent indicates understanding of the purpose of leucovorin therapy after the methotrexate? 1. "I'm glad I only need one dose of the leucovorin." 2. "I don't have any pain so I won't need to take the leucovorin this time." 3. "I know I will be taking the leucovorin every 6 hours for about the next 3 days." 4. "I don't have any nausea so I won't need the leucovorin."

Answer: 3 Explanation: 1. Leucovorin (citrovorum factor) is a form of folic acid that helps to protect normal cells from the destructive action of methotrexate. It is started within 24 hours of methotrexate administration and is given along with hydration therapy. Usual administration is every 6 hours for 72 hours or until serum methotrexate is at the desired level.

A child diagnosed with a Wilms tumor is prescribed chemotherapy. Which laboratory test will the nurse monitor prior to administering the chemotherapy to determine the child's infection-fighting capability? 1. Hemoglobin 2. RBC count 3. Absolute neutrophil count (ANC) 4. Platelets

Answer: 3 Explanation: 1. The absolute neutrophil count uses both the segmented (mature) and bands (immature) neutrophils as a measure of the body's infection-fighting capability. RBC count, hemoglobin, and platelets cannot determine infection-fighting capabilities.

The antiemetic drug ondansetron (Zofran) is administered to a child receiving chemotherapy. When should the nurse administer this medication? 1. Only if the child experiences nausea 2. After the chemotherapy has been administered 3. Before chemotherapy administration as a prophylactic measure 4. Never; this antiemetic is not effective for controlling nausea and vomiting associated with chemotherapy

Answer: 3 Explanation: 1. The antiemetic ondansetron (Zofran) should be administered before chemotherapy as a prophylactic measure. Giving it after the child has nausea or at the end of chemotherapy treatment does not help with preventing nausea. It is the drug of choice for controlling nausea caused by chemotherapy agents.

The child is admitted to the hospital after being diagnosed with retinoblastoma. Which assessment finding does the nurse anticipate for this child? 1. A red reflex 2. Yellow sclera 3. A white pupil 4. Blue-tinged sclera

Answer: 3 Explanation: 1. The first sign of retinoblastoma is a white pupil. The red reflex is absent. Yellow sclera is a sign of jaundice, not retinoblastoma. Blue-tinged sclera is a sign of osteogenesis imperfecta, not retinoblastoma.

A child who is diagnosed with leukemia has a sibling who is expressing feelings of anger and guilt. How would the nurse characterize this reaction by the sibling? 1. Abnormal; the sibling should be referred to a psychologist. 2. Normal; the illness doesn't affect the sibling. 3. Unexpected; the cancer is easily treated. 4. Normal; the sibling is affected too, and anger and guilt are expected feelings.

Answer: 4 Explanation: 1. A diagnosis of cancer affects the whole family, and initial feelings experienced by the sibling may be anger and guilt. Seldom will the sibling be unaffected; however, the response is not abnormal.

The nurse is monitoring the urine specific gravity and pH on a child receiving chemotherapy. Which urinalysis result is the goal for this child? 1. Spec gravity 1.030; pH 6 2. Spec gravity 1.030; pH 7.5 3. Spec gravity 1.005; pH 6 4. Spec gravity 1.005; pH 7.5

Answer: 4 Explanation: 1. Because the breakdown of malignant cells releases intracellular components into the blood and electrolyte imbalance causes metabolic acidosis, the urine specific gravity should remain at less than 1.010 and the pH at 7 to 7.5. A specific gravity higher than 1.010 can mean fluid intake is not high enough, and a pH of less than 7 means acidosis.

The child has just been diagnosed with osteosarcoma, and the nurse is teaching the family regarding this type of cancer. The nurse knows that instruction has been successful when the family states that osteosarcoma is common in which age group? 1. Infants 2. Toddlers 3. Preschool-age children 4. School-age children 5. Adolescents

Answer: 5 Explanation: 1. Osteosarcoma's peak incidence is during the rapid growth years, at age 13 for girls and 14 for boys.