Chapter 25: The Child with Cancer

Daily toothbrushing and flossing can be encouraged for the child on chemotherapy when the platelet count is above which? a. 10,000/mm3 b. 20,000/mm3 c. 30,000/mm3 d. 40,000/mm3

ANS: D Daily toothbrushing and flossing are encouraged in children with platelet counts above 40,000/mm3.

What chemotherapeutic agent is classified as an antitumor antibiotic? a. Cisplatin (Platinol AQ) b. Vincristine (Oncovin) c. Methotrexate (Texall) d. Daunorubicin (Cerubidine)

ANS: D Daunorubicin is an antitumor antibiotic. Cisplatin is classified as an alkylating agent. Vincristine is a plant alkaloid. Methotrexate is an antimetabolite

A child has an absolute neutrophil count (ANC) of 500/mm3. The nurse should expect to be administering which prescribed treatment? a. Platelets b. Packed red blood cells c. Zofran (ondansetron) d. G-CSF (Neupogen) daily

ANS: D G-CSF (filgrastim [Neupogen], pegfilgrastim [Neulasta]) directs granulocyte development and can decrease the duration of neutropenia following immunosuppressive therapy. G-CSF is discontinued when the ANC surpasses 10,000/mm3.

What specific gravity of the urine is desired so that hemorrhagic cystitis is prevented? a. 1.035 b. 1.030 c. 1.025 d. 1.005

ANS: D Sterile hemorrhagic cystitis is a side effect of chemical irritation to the bladder from chemotherapy or radiotherapy. It can be prevented by a liberal oral or parenteral fluid intake (at least one and a half times the recommended daily fluid requirement). The urine should be dilute so 1.005 is the expected specific gravity

The nurse is admitting a patient who is jaundiced due to pancreatic cancer. The nurse should give the highest priority to which of the following needs? A. Nutrition B. Self-image C. Skin integrity D. Urinary elimination

A (A. Profound weight loss and anorexia occur with pancreatic cancer. Correct. B. jaundiced patients are concerned about how they look, but physiological needs take priority C. jaundice causes dry skin and pruritis, scratching can lead to skin breakdown D. urine is dark due to obstructive process, kidney function is not affected)

A nurse is discussing childhood cancer with the parents of a child in an oncology unit. Which statement by the nurse would be the most accurate? A. "The most common site for children's cancer is the bone marrow." B. "All childhood cancers have a high mortality rate." C. "Children with leukemia have a higher survival rate if they are older than 11 when diagnosed." D. "The prognosis for children with cancer isn't affected by treatment strategies."

A (Childhood cancers occur most commonly in rapidly growing tissue, especially in the bone marrow. Mortality depends on the time of diagnosis, the type of cancer, and the age at which the child was diagnosed. Children who are diagnosed between the ages of 2 and 9 consistently demonstrate a better prognosis. Treatment strategies are tailored to produce the most favarable prognosis.)

A nurse is teaching a client about the risk factors associated with colorectal cancer. The nurse determines that further teaching related to the colo-rectal cancer is necessary if the client identifies which of the following as an associated risk factor? A. Age younger than 50 years B. History of coloractal polyps C. Family history of colorectal cancer D. Chronic inflammatory bowel disease"

A (Colorectal cancer risk factors include age older than 50 years, a family history of the disease, colorectal polyps, and chronic inflammatory bowel disease.)

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.)

The mother of a 4 year old child brings the child to the clinic and tells the pediatric nurse specialist that the child's abdomen seems to be swollen. During further assessment of the subjective data, the mother tells the nurse that the child has been eating well and that the activity level of the child is unchanged. The nurse, suspecting the possibility of a Wilm's tumor, would avoid which of the following during the physical assessment? A. Palpating the abdomen for a mass. B. Assessing the urine for hematuria C. Monitoring the temperature for presence of fever D. Monitoring the blood pressure for presence of hypertension

A (Rationale: Wilm's tumor is the most common intra-abdominal and kidney tumor of childhood. If Wilm's tumor is suspected, the tumor mass should not be palpated by the nurse. Excessive manipulation can cause the seeding of the tumor and spread of cancerous cells. Fever, hematuria, and hypertension are all clinical manifestations of Wilm's tumor.)

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.)

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 (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.)

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.)

Which nursing diagnosis is highest-priority for a child undergoing chemotherapy and experiencing nausea and vomiting? A. Fluid and Electrolyte Imbalance B. Alterations in Nutrition C. Alterations in Skin Integrity D. Body Image Disturbances

A (While all of the nursing diagnoses listed here are important, dehydration and fluid and electrolyte loss secondary to vomiting is the priority for this client.)

A child is diagnosed with Wilms' tumor. In planning teaching interventions, what key point should the nurse emphasize to the parents? A. Do not put pressure on the abdomen. B. Frequent visits from friends and family will improve morale. C. Appropriate protective equipment should be worn for contact sports. D. Encourage the child to remain active."

A (Do not put pressure on the abdomen. Palpation of Wilms' tumor can cause rupture and spread of cancerous cells. Frequent visitation might allow the child to be exposed to more infections, and activity and sports are discouraged because of the risk of rupture of the encapsulated tumor.)

The mother of a child diagnosed with a potentially life-threatening form of cancer says to the nurse, "I don't understand how this could happen to us. We have been so careful to make sure our child is healthy." Which response by the nurse is most appropriate? A. "This must be a difficult time for you and your family. Would you like to talk about how you are feeling?" B. "Why do you say that? Do you think that you could have prevented this?" C. "You shouldn't feel that you could have prevented the cancer. It is not your fault." D. "Many children are diagnosed with cancer. It is not always life-threatening."

A (Parents of children diagnosed with cancer require major emotional support, and should be allowed to express their feelings. Prevention and blaming oneself is not supportive, nor is telling the parents that there are many other children with cancer.)

A young child with leukemia has anorexia and severe stomatitis. What approach should the nurse suggest that the parents try? a. Relax any eating pressures. b. Firmly insist that the child eat normally. c. Serve foods that are either hot or cold. d. Provide only liquids because chewing is painful.

ANS: A A multifaceted approach is necessary for children with severe stomatitis and anorexia. First, the parents should relax eating pressures. The nurse should suggest that the parents try soft, bland foods; normal saline or bicarbonate mouthwashes; and local anesthetics. Insisting that the child eat normally is not suggested. For some children, not eating may be a way to maintain some control. This can set the child and caregiver in opposition to each other. Hot and cold foods can be painful on ulcerated mucosal membranes. Substitution of high-calorie foods that the child likes and can eat should be used.

After chemotherapy is begun for a child with acute leukemia, prophylaxis to prevent acute tumor lysis syndrome includes which therapeutic intervention? a. Hydration b. Oxygenation c. Corticosteroids d. Pain management

ANS: A Acute tumor lysis syndrome results from the release of intracellular metabolites during the initial treatment of leukemia. Hyperuricemia, hypocalcemia, hyperphosphatemia, and hyperkalemia can result. Hydration is used to reduce the metabolic consequences of the tumor lysis. Oxygenation is not helpful in preventing acute tumor lysis syndrome. Allopurinol, not corticosteroids, is indicated for pharmacologic management. Pain management may be indicated for supportive therapy of the child, but it does not prevent acute tumor lysis syndrome.

What is appropriate mouth care for a toddler with mucosal ulceration related to chemotherapy? a. Mouthwashes with plain saline b. Lemon glycerin swabs for cleansing c. Mouthwashes with hydrogen peroxide d. Swish and swallow with viscous lidocaine

ANS: A Administering mouth care is particularly difficult in infants and toddlers. A satisfactory method of cleaning the gums is to wrap a piece of gauze around a finger; soak it in saline or plain water; and swab the gums, palate, and inner cheek surfaces with the finger. Mouth rinses are best accomplished with plain water or saline because the child cannot gargle or spit out excess fluid. Avoid agents such as lemon glycerin swabs and hydrogen peroxide because of the drying effects on the mucosa. Lidocaine should be avoided in young children

A child has been diagnosed with a Wilms tumor. What should preoperative nursing care include? a. Careful bathing and handling b. Monitoring of behavioral status c. Maintenance of strict isolation d. Administration of packed red blood cells

ANS: A Careful bathing and handling are important in preventing trauma to the Wilms tumor site

What are the most common clinical manifestations of brain tumors in children? a. Headaches and vomiting b. Blurred vision and ataxia c. Hydrocephalus and clumsy gait d. Fever and poor fine motor control

ANS: A Headaches, especially on awakening, and vomiting that is not related to feeding are the most common clinical manifestations of brain tumors in children. Diplopia (double vision), not blurred vision, can be a presenting sign of brainstem glioma. Ataxia is a clinical manifestation of brain tumors, but headaches and vomiting are the most common. Hydrocephalus can be a presenting sign in infants when the sutures have not closed. Children at this age are usually not walking steadily. Poor fine motor coordination may be a presenting sign of astrocytoma, but headaches and vomiting are the most common presenting signs of brain tumors

An adolescent is scheduled for a leg amputation in 2 days for treatment of osteosarcoma. What approach should the nurse implement? a. Answer questions with straightforward honesty. b. Avoid discussing the seriousness of the condition. c. Explain that although the amputation is difficult, it will cure the cancer. d. Help the adolescent accept the amputation as better than a long course of chemotherapy.

ANS: A Honesty is essential to gain the child's cooperation and trust. The diagnosis of cancer should not be disguised with falsehoods. The adolescent should be prepared for the surgery so there is time for reflection about the diagnosis and subsequent treatment. This allows questions to be answered. To accept the need for radical surgery, the child must be aware of the lack of alternatives for treatment. Amputation is necessary, but it will not guarantee a cure. Chemotherapy is an integral part of the therapy with surgery. The child should be informed of the need for chemotherapy and its side effects before surgery

What are favorable prognostic criteria for acute lymphoblastic leukemia? (Select all that apply.) a. Male gender b. CALLA positive c. Early pre-B cell d. 2 to 10 years of age e. Leukocyte count 750,000/mm3

ANS: B, C, D Favorable prognostic criteria for acute lymphoblastic leukemia include CALLA positive, early pre-B cell, and age 2 to 10 years. Leukocyte count less, not greater, than 50,000/mm3 and female, not male, gender are favorable prognostic criteria

One pediatric oncologic emergency is acute tumor lysis syndrome. Symptoms that this may be occurring include what? a. Muscle cramps and tetany b. Respiratory distress and cyanosis c. Thrombocytopenia and sepsis d. Upper extremity edema and neck vein distension

ANS: A Risk factors for development of tumor lysis syndrome include a high white blood cell count at diagnosis, large tumor burden, sensitivity to chemotherapy, and high proliferative rate. In addition to the described metabolic abnormalities, children may develop a spectrum of clinical symptoms, including flank pain, lethargy, nausea and vomiting, muscle cramps, pruritus, tetany, and seizures. Respiratory distress and cyanosis occur with hyperleukocytosis. Thrombocytopenia and sepsis occur with disseminated intravascular coagulation. Upper extremity edema and neck vein distention occur with superior vena cava syndrome

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? a. The sibling can get a varicella vaccination. b. The sibling should not get a varicella vaccination. c. The sibling should wait until the child is finished with chemotherapy. d. The sibling should get varicella-zoster immune globulin if exposed to chickenpox.

ANS: A Siblings and other family members can receive the live measles, mumps, and rubella vaccine and the varicella vaccine without risk to the child who is immunosuppressed

As part of the diagnostic evaluation of a child with cancer, biopsies are important for staging. What statement explains what staging means? a. Extent of the disease at the time of diagnosis b. Rate normal cells are being replaced by cancer cells c. Biologic characteristics of the tumor or lymph nodes d. Abnormal, unrestricted growth of cancer cells producing organ damage

ANS: A Staging is a description of the extent of the disease at the time of diagnosis. Staging criteria exist for most tumors. The stage usually relates directly to the prognosis; the higher the stage, the poorer the prognosis. The rate that normal cells are being replaced by cancer cells is not a definition of staging. Classification of the tumor refers to the biologic characteristics of the tumor or lymph nodes. Abnormal, unrestricted growth of cancer cells producing organ damage describes how cancer cells grow and can cause damage to an organ

The nurse should expect to care for which age of child if the admitting diagnosis is retinoblastoma? a. Infant or toddler b. Preschool- or school-age child c. School-age or adolescent child d. Adolescent

ANS: A The average age of the child at the time of diagnosis is 2 years, and bilateral and hereditary disease is diagnosed earlier than unilateral and nonhereditary disease.

In teaching parents how to minimize or prevent bleeding episodes when the child is myelosuppressed, the nurse includes what information? a. Meticulous mouth care is essential to avoid mucositis. b. Rectal temperatures are necessary to monitor for infection. c. Intramuscular injections are preferred to intravenous ones. d. Platelet transfusions are given to maintain a count greater than 50,000/mm3.

ANS: A The decrease in blood platelets secondary to the myelosuppression of chemotherapy can cause an increase in bleeding. The child and family are taught how to perform good oral hygiene to minimize gingival bleeding and mucositis. Rectal temperatures are avoided to minimize the risk of ulceration. Hygiene is also emphasized. Intramuscular injections are avoided because of the risk of bleeding into the muscle and of infection. Platelet transfusions are usually not given unless there is active bleeding or the platelet count is less than 10,000/mm3. The use of platelets when not necessary can contribute to antibody formation and increased destruction of platelets when transfused.

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? a. 1 to 3 days b. 4 to 6 days c. 7 to 9 days d. 10 to 12 days

ANS: A Transfused platelets generally survive in the body for 1 to 3 days. The peak effect is reached in about 1 hour and decreased by half in 24 hours

A child is receiving vincristine (Oncovin). The nurse should monitor for which side effect of this medication? a. Diarrhea b. Photosensitivity c. Constipation d. Ototoxicity

ANS: A Vincristine, and to a lesser extent vinblastine, can cause various neurotoxic effects. One of the more common neurotoxic effects is severe constipation caused from decreased bowel innervation.

What strategies should the nurse implement to increase nutritional intake for the child receiving chemotherapy? (Select all that apply.) a. Allow the child any food tolerated. b. Fortify foods with nutritious supplements. c. Allow the child to be involved in food selection. d. Encourage the parents to place pressure on the importance of eating. e. Encourage the child to eat favorite foods during infusion of chemotherapy medications.

ANS: A, B, C To increase nutritional intake for the child receiving chemotherapy, the nurse should allow the child any food tolerated, fortify foods with nutritious supplements, and allow the child to be involved in food selection. The parents should be encouraged to reduce pressure placed on eating. Some children develop aversions to certain foods if they are eaten during chemotherapy. It is best to refrain from offering the child's favorite foods while the child is receiving chemotherapy.

A child on chemotherapy has developed rectal ulcers. What interventions should the nurse teach to the child and parents to relieve the discomfort of rectal ulcers? (Select all that apply.) a. Warm sitz baths b. Use of stool softeners c. Record bowel movements d. Use of an opioid for discomfort e. Occlusive ointment applied to the area

ANS: A, B, C, E If rectal ulcers develop, meticulous toilet hygiene, warm sitz baths after each bowel movement, and an occlusive ointment applied to the ulcerated area promote healing; the use of stool softeners is necessary to prevent further discomfort. Parents should record bowel movements because the child may voluntarily avoid defecation to prevent discomfort. Opioids would cause increased constipation.

The nurse should teach the family that which residual disabilities can occur for a child being treated for a brain tumor? (Select all that apply.) a. Ataxia b. Anorexia c. Dysphagia d. Sensory deficits e. Crania nerve palsies

ANS: A, C, D, E Even with children who are long-term survivors after treatment for a brain tumor, residual disabilities, such as short stature, cranial nerve palsies, sensory defects, motor abnormalities (especially ataxia), intellectual deficits, dysphagia, dysgraphia, and behavioral problems, may occur. Anorexia is not a residual disability.

The nurse is precepting a new graduate nurse at an ambulatory pediatric hematology and oncology clinic. What cardinal signs of cancer in children should the nurse make the new nurse aware of? (Select all that apply.) a. Sudden tendency to bruise easily b. Transitory, generalized pain c. Frequent headaches d. Excessive, rapid weight gain e. Gradual, steady fever f. Unexplained loss of energy

ANS: A, C, F The cardinal signs of cancer in children include a sudden tendency to bruise easily; frequent headaches, often with vomiting; and an unexplained loss of energy. Other cardinal signs include persistent, localized pain; excessive, rapid weight loss; and a prolonged, unexplained fever.

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? a. "You should give your child aspirin instead of acetaminophen for fever or pain." b. "Your child should avoid contact sports or activities that could cause bleeding." c. "You should feed your child a bland, soft, moist diet for the next week." d. "Your child should avoid large groups of people for the next week."

ANS: B A child with a low platelet count needs to avoid activities that could cause bleeding such as playing contact sports, climbing trees, using playground equipment, or bike riding. The child should be given acetaminophen, not aspirin, for fever or pain; the child does not need to be on a soft, bland diet or avoid large groups of people because of the low platelet count

A child with osteosarcoma is experiencing phantom limb pain after an amputation. What prescribed medication is effective for short-term phantom pain relief? a. Phenytoin (Dilantin) b. Gabapentin (Neurontin) c. Valproic Acid (Depakote) d. Phenobarbital (Phenobarbital)

ANS: B A recent Cochrane review reported that various medications have been used for phantom limb pain but complete pain relief has been unsuccessful. Morphine, gabapentin, and ketamine are effective for short-term pain relief.

Essential postoperative nursing management of a child after removal of a brain tumor includes which nursing care? a. Turning and positioning every 2 hours b. Measuring all fluid intake and output c. Changing the dressing when it becomes soiled d. Using maximum lighting to ensure accurate observations

ANS: B After brain surgery, cerebral edema is a risk. Careful monitoring is essential. All fluids, including intravenous antibiotics, are included in the intake. Turning and positioning depend on the surgical procedure. When large tumors are removed, the child is usually not positioned on the operative side. The dressing is not changed. It is reinforced with gauze after the amount of drainage is marked and estimated. A quiet, dimly lit environment is optimum to decrease stimulation and relieve discomfort such as headaches.

An adolescent will receive a bone marrow transplant (BMT). The nurse should explain that the bone marrow will be administered by which method? a. Bone grafting b. Intravenous infusion c. Bone marrow injection d. Intraabdominal infusion

ANS: B Bone marrow from a donor is infused intravenously, and the transfused stem cells migrate to the recipient's marrow and repopulate it.

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? a. White blood cell count, 17,000/mm3; hemoglobin, 15 g/dl b. White blood cell count, 3,000/mm3; hemoglobin, 11.5 g/dl c. Platelets, 450,000/mm3; hemoglobin, 12 g/dl d. White blood cell count, 10,000/mm3; platelets, 175,000/mm3

ANS: B Chemotherapy is the mainstay of therapy for extensive local or disseminated neuroblastoma. The drugs of choice are vincristine, doxorubicin, cyclophosphamide, cisplatin, etoposide, ifosfamide, and carboplatin. These cause immunosuppression, so the laboratory values will indicate a low white blood cell count and hemoglobin.

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? a. Ketones b. Catecholamines c. Red blood cells d. Excessive white blood cells

ANS: B Neuroblastomas, particularly those arising on the adrenal glands or from a sympathetic chain, excrete the catecholamines epinephrine and norepinephrine. Urinary excretion of catecholamines is detected in approximately 95% of children with adrenal or sympathetic tumors.

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? a. Rinsing mouth with water b. Daily toothbrushing and flossing c. Lemon glycerin swabs for cleansing d. Wiping teeth with moistened gauze or Toothettes

ANS: B Oral care is essential for children receiving chemotherapy to prevent infections and other complications. When the child's granulocyte count is above 500/mm3 and platelet count is above 40,000/mm3, daily brushing and flossing are recommended. Rinsing the mouth with water is not effective for oral hygiene. Lemon glycerin swabs are avoided because they have a drying effect on the mucous membranes, and the lemon may irritate eroded tissue and decay the child's teeth. Wiping teeth with moistened gauze or Toothettes is recommended when the child's granulocyte count is below 500/mm3 and platelet count is below 40,000/mm3

What childhood cancer may demonstrate patterns of inheritance that suggest a familial basis? a. Leukemia b. Retinoblastoma c. Rhabdomyosarcoma d. Osteogenic sarcoma

ANS: B Retinoblastoma is an example of a pediatric cancer that demonstrates inheritance. The absence of the retinoblastoma gene allows for abnormal cell growth and the development of retinoblastoma. Chromosome abnormalities are present in many malignancies. They do not indicate a familial pattern of inheritance. The Philadelphia chromosome is observed in almost all individuals with chronic myelogenous leukemia. There is no evidence of a familial pattern of inheritance for rhabdomyosarcoma or osteogenic sarcoma cancers

A 5-year-old child is being prepared for surgery to remove a brain tumor. Preparation for surgery should be based on which information? a. Removal of the tumor will stop the various signs and symptoms. b. Usually the postoperative dressing covers the entire scalp. c. He is not old enough to be concerned about his head being shaved. d. He is not old enough to understand the significance of the brain.

ANS: B The child should be told what he will look and feel like after surgery. This includes the anticipated size of the dressing. The nurse can demonstrate on a doll the expected size and shape of the dressing. Some of the symptoms may be alleviated by removal of the tumor, but postsurgical headaches and cerebellar symptoms such as ataxia may be aggravated. Children should be prepared for the loss of their hair, and it should be removed in a sensitive, positive manner if the child is awake. Children at this age have poorly defined body boundaries and little knowledge of internal organs. Intrusive experiences are frightening, especially those that disrupt the integrity of the skin.

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? a. Administer the chemotherapy between meals. b. Give an antiemetic before chemotherapy begins. c. Have the child bring favorite foods for snacks. d. Keep the child NPO (nothing by mouth) until nausea and vomiting subside.

ANS: B The most beneficial regimen to minimize nausea and vomiting associated with chemotherapy is to administer a 5-hydroxytryptamine-3 receptor antagonist (e.g., ondansetron) before the chemotherapy is begun. The goal is to prevent anticipatory signs and symptoms. The child will experience nausea with chemotherapy whether or not food is present in the stomach. Because some children develop aversions to foods eaten during chemotherapy, refraining from offering favorite foods is advised. Keeping the child NPO until nausea and vomiting subside will help with this episode, but the child will have discomfort and be at risk for dehydration.

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? a. "It is sad for the other family but good news for your child." b. "Each child has an 80% likelihood of 5-year survival." c. "The data suggest that 20% of the children in the clinic will die. There are still many hurdles for your son." d. "You should avoid the grieving family because you will be benefiting from their loss."

ANS: B This is a common misconception for parents. The success data are based on numerous factors, including the effectiveness of the protocol and the child's response. These are aggregate data that apply to each child and do not depend on the success or failure in other children. The failure of one child in a protocol does not improve the success rate for other children. Although the son does face more hurdles, these are aggregate data, not specific to the clinic. It may be difficult for this family to be supportive given their concerns about their child. Families usually form support groups in pediatric oncology settings, and support during bereavement is common.

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? a. Recheck the rate of drug infusion. b. Stop the drug infusion immediately. c. Observe the child closely for next 10 minutes. d. Explain to the child that this is an expected side effect.

ANS: B When an allergic reaction is suspected, the drug is immediately discontinued. Any drug in the line should be withdrawn, and a normal saline infusion begun to keep the line open. The intravenous infusion is stopped to minimize the amount of drug that infuses. The infusion rate can be confirmed at a later time. Observation of the child for 10 minutes is essential, but it is done after the infusion is stopped. These signs are indicative of an allergic reaction, not an expected response.

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? a. Brain tumor b. Retinoblastoma c. Neuroblastoma d. Rhabdomyosarcoma

ANS: B When the nurse examines the eye, the light will reflect off of the tumor, giving the eye a whitish appearance. This is called a cat's eye reflex. Brain tumors are not usually visible. Neuroblastoma usually arises from the adrenal medulla and sympathetic nervous system. The most common presentation sites are in the abdomen, head, neck, or pelvis. Supraorbital ecchymosis may be present with distant metastasis. Rhabdomyosarcoma is a soft tissue tumor that derives from skeletal muscle undifferentiated cells.

What guidelines should the nurse follow when handling chemotherapeutic agents? (Select all that apply.) a. Use clean technique. b. Prepare medications in a safety cabinet. c. Wear gloves designed for handling chemotherapy. d. Wear face and eye protection when splashing is possible. e. Discard gloves and protective clothing in a special container.

ANS: B, C, D, E Safe handling of chemotherapeutic agents includes preparing medications in a safety cabinet, wearing gloves designed for handling chemotherapy, wearing face and eye protection when splashing is possible, and discarding gloves and protective clothing in a special container. Aseptic, not clean, technique should be used

The nurse is caring for a child with retinoblastoma that was treated with an enucleation. What interventions should the nurse plan for care of an eye socket after enucleation? (Select all that apply.) a. Clean the prosthesis. b. Change the eye pad daily. c. Keep the opposite eye covered initially. d. Irrigate the socket daily with a prescribed solution. e. Apply a prescribed antibiotic ointment after irrigation.

ANS: B, D, E Care of the socket is minimal and easily accomplished. The wound itself is clean and has little or no drainage. If an antibiotic ointment is prescribed, it is applied in a thin line on the surface of the tissues of the socket. To cleanse the site, an irrigating solution may be ordered and is instilled daily or more frequently if necessary before application of the antibiotic ointment. The dressing consists of an eye pad changed daily. The prosthesis is not placed until the socket has healed. The opposite eye is not covered

What chemotherapeutic agent can cause an anaphylactic reaction? a. Prednisone (Deltasone) b. Vincristine (Oncovin) c. L-Asparaginase (Elspar) d. Methotrexate (Trexall)

ANS: C A potentially fatal complication is anaphylaxis, especially from L-asparaginase, bleomycin, cisplatin, and etoposide (VP-16).

What type of chemotherapeutic agent alters the function of cells by replacing a hydrogen atom of a molecule? a. Plant alkaloids b. Antimetabolites c. Alkylating agents d. Antitumor antibiotics

ANS: C Alkylating agents replace a hydrogen atom with an alkyl group. The irreversible combination of alkyl groups with nucleotide chains, particularly deoxyribonucleic acid (DNA), causes unbalanced growth of unaffected cell constituents so that the cell eventually dies. Plant alkaloids arrest the cell in metaphase by binding to proteins needed for spindle formation. Antimetabolites resemble essential metabolic elements needed for growth but are different enough to block further DNA synthesis. Antitumor antibiotics are natural substances that interfere with cell division by reacting with DNA in such a way as to prevent further replication of DNA and transcription of ribonucleic acid (RNA).

The nurse is preparing a child for possible alopecia from chemotherapy. What information should the nurse include? a. Wearing hats or scarves is preferable to a wig. b. Expose head to sunlight to stimulate hair regrowth. c. Hair may have a slightly different color or texture when it regrows. d. Regrowth of hair usually begins 12 months after chemotherapy ends.

ANS: C Alopecia is a side effect of certain chemotherapeutic agents and cranial irradiation. When the hair regrows, it may be of a different color or texture. Children should choose the head covering they prefer. A wig should be selected similar to the child's own hairstyle and color before the hair loss. The head should be protected from sunlight to avoid sunburn. The hair usually grows back within 3 to 6 months after the cessation of treatment.

Chemotherapeutic agents are classified according to what feature? a. Side effects b. Effectiveness c. Mechanism of action d. Route of administration

ANS: C Chemotherapeutic agents are classified according to mechanism of action. For example, antimetabolites resemble essential metabolic elements needed for growth but are different enough to block further deoxyribonucleic acid (DNA) synthesis. Although the side effect profiles may be similar for drugs within a classification, they are not the basis for classification. Most chemotherapeutic regimens contain combinations of drugs. The effectiveness of any one drug is relative to the cancer type, combination therapy, and protocol for administration. The route of administration is determined by the pharmacodynamics and pharmacokinetics of each drug.

A child with leukemia is receiving intrathecal chemotherapy to prevent which condition? a. Infection b. Brain tumor c. Central nervous system (CNS) disease d. Drug side effects

ANS: C Children with leukemia are at risk for invasion of the CNS with leukemic cells. CNS prophylactic therapy is indicated. Intrathecal chemotherapy does not prevent infection or drug side effects. A brain tumor in a child with leukemia would be a second tumor, and additional appropriate therapy would be indicated.

Calculate the absolute neutrophil count (ANC) for the following: WBC count of 5000 mm3; neutrophils (segs) of 10%; and nonsegmented neutrophils (bands) of 12%. a. 110/mm3 b. 500/mm3 c. 1100/mm3 d. 5000/mm3

ANS: C Determine the total percentage of neutrophils ("polys," or "segs," and "bands"). Multiply white blood cell (WBC) count by percentage of neutrophils. WBC = 1000/mm3, neutrophils = 7%, and nonsegmented neutrophils (bands) = 7% Step 1: 10% + 12% = 22% Step 2: 0.22 5000 = 1100/mm3 ANC

Nursing care of the child with myelosuppression from leukemia or chemotherapeutic agents should include which therapeutic intervention? a. Restrict oral fluids. b. Institute strict isolation. c. Use good hand-washing technique. d. Give immunizations appropriate for age.

ANS: C Good hand washing minimizes the exposure to infectious organisms and decreases the chance of infection spread. Oral fluids are encouraged if the child is able to drink. If possible, the intravenous route is not used because of the increased risk of infection from parenteral fluid administration. Strict isolation is not indicated. When the child is immunocompromised, the vaccines are not effective. If necessary, the appropriate immunoglobulin is administered

What side effect commonly occurs with corticosteroid (prednisone) therapy? a. Alopecia b. Anorexia c. Nausea and vomiting d. Susceptibility to infection

ANS: D Corticosteroids have immunosuppressive effects. Children who are taking prednisone are susceptible to infections. Hair loss is not a side effect of corticosteroid therapy. Children taking corticosteroids have increased appetites. Gastric irritation, not nausea and vomiting, is a potential side effect. The medicine should be given with food

What description identifies the pathophysiology of leukemia? a. Increased blood viscosity b. Abnormal stimulation of the first stage of coagulation process c. Unrestricted proliferation of immature white blood cells (WBCs) d. Thrombocytopenia from an excessive destruction of platelets

ANS: C Leukemia is a group of malignant disorders of the bone marrow and lymphatic system. It is defined as an unrestricted proliferation of immature WBCs in the blood-forming tissues of the body. Increased blood viscosity may result secondary to the increased number of WBCs. The coagulation process is unaffected by leukemia. Thrombocytopenia may occur secondary to the overproduction of WBCs in the bone marrow.

What statement related to clinical trials developed for pediatric cancers is most accurate? a. Are accessible only in major pediatric centers b. Do not require consent for standard therapy c. Provide the best available therapy compared with an expected improvement d. Are standardized to provide the same treatment to all children with the disease

ANS: C Most clinical trials have a control group in which the patients receive the best available therapy currently known. The experimental group(s) receives treatment that is thought to be even better. The protocol outlines the therapy plan. Protocols are developed for many pediatric cancers. They can be accessed by pediatric oncologists throughout the United States. Consent is always required in treatment of children, especially for research protocols. The protocol is designed to optimize therapy for children based on disease type and stage

What is an important priority in dealing with the child suspected of having Wilms tumor? a. Intervening to minimize bleeding b. Monitoring temperature for infection c. Ensuring the abdomen is protected from palpation d. Teaching parents how to manage the parenteral nutrition

ANS: C Wilms tumor, or nephroblastoma, is the most common malignant renal and intraabdominal tumor of childhood. The abdomen is protected, and palpation is avoided. Careful handling and bathing are essential to prevent trauma to the tumor site. Before chemotherapy, the child is not myelosuppressed. Bleeding is not usually a risk. Infection is a concern after surgery and during chemotherapy, not before surgery. Parenteral therapy is not indicated before surgery

What is a common clinical manifestation of Hodgkin disease? a. Petechiae b. Bone and joint pain c. Painful, enlarged lymph nodes d. Nontender enlargement of lymph nodes

ANS: D Asymptomatic, enlarged cervical or supraclavicular lymphadenopathy is the most common presentation of Hodgkin disease. Petechiae are usually associated with leukemia. Bone and joint pain are not likely in Hodgkin disease. The enlarged nodes are rarely painful

What pain management approach is most effective for a child who is having a bone marrow test? a. Relaxation techniques b. Administration of an opioid c. EMLA cream applied over site d. Conscious or unconscious sedation

ANS: D Children need explanations before each procedure that is being done to them. Effective pharmacologic and nonpharmacologic measures should be used to minimize pain associated with procedures. For bone marrow aspiration, conscious or unconscious sedation should be used. Relaxation, opioids, and EMLA can be used to augment the sedation

Postoperative positioning for a child who has had a medulloblastoma brain tumor (infratentorial) removed should be which? a. Trendelenburg b. Head of bed elevated above heart level c. Flat on operative side with pillows behind the head d. Flat, on either side with pillows behind the back

ANS: D The child with an infratentorial procedure is usually positioned flat and on either side. Pillows should be placed against the child's back, not head, to maintain the desired position. The Trendelenburg position is contraindicated in both infratentorial and supratentorial surgeries because it increases intracranial pressure and the risk of hemorrhage.

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? a. BMT should be done at the time of diagnosis. b. Parents and siblings of the child have a 25% chance of being a suitable donor. c. If BMT fails, chemotherapy or radiotherapy will need to be continued. d. Finding a suitable donor involves matching antigens from the human leukocyte antigen (HLA) system.

ANS: D The most successful BMTs come from suitable HLA-matched donors. The timing of a BMT depends on the disease process involved. It usually follows intensive high-dose chemotherapy or radiotherapy. Usually, parents only share approximately 50% of the genetic material with their children. A one in four chance exists that two siblings will have two identical haplotypes and will be identically matched at the HLA loci. The decision to continue chemotherapy or radiotherapy if BMT fails is not appropriate to discuss with the parents when planning the BMT. That decision will be made later.

What immunization should not be given to a child receiving chemotherapy for cancer? a. Tetanus vaccine b. Inactivated poliovirus vaccine c. Diphtheria, pertussis, tetanus (DPT) d. Measles, mumps, rubella (MMR)

ANS: D The vaccine used for MMR is a live virus and can cause serious disease in immunocompromised children. The tetanus vaccine, inactivated poliovirus vaccine, and DPT are not live vaccines and can be given to immunosuppressed children. The immune response is likely to be suboptimum, so delaying vaccination is usually recommended

Total-body irradiation is indicated for what reason? a. Palliative care b. Lymphoma therapy c. Definitive therapy for leukemia d. Preparation for bone marrow transplant

ANS: D Total-body irradiation is used as part of the destruction of the child's immune system necessary for a bone marrow transplant. The child is at great risk for complications because there is no supportive therapy until engraftment of the donor marrow takes place. Irradiation for palliative care is done selectively. The area that is causing pain or potential obstruction is irradiated. Lymphoma and leukemia are treated through a combination of modalities. Total-body irradiation is not indicated.

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)

The parent of a child undergoing chemotherapy asks the nurse why the child must wear a mask in public places. Which of the following responses by the nurse would be most appropriate? A. "Chemotherapy causes dry mouth, and the mask will help contain moisture." B. "Chemotherapy decreases immune system function, increasing the risk of acquiring an infection." C. "Chemotherapy makes the oral mucous membranes deteriorate and makes them susceptible to infection." D, "Chemotherapy kills cancer cells, and your child might spread those cells to others."

B (Chemotherapeutic agents decrease the immunity of the child. Proper use of the mask will decrease the chance of acquiring an infection. Cancer is not spread; a mask cannot contain moisture; and unsightly mouth sores are not a medical reason to wear a mask.)

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 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.)

After teaching the parents of a child newly diagnosed with leukemia about the disease, which of the following descriptions given by the mother best indicates that she understands the nature of leukemia? A) "The disease is an infection resulting in increased white blood cell production." B) "The disease is a type of cancer characterized by an increase in immature white blood cells." C) "The disease is an inflammation associated with enlargement of the lymph nodes." D) "The disease is an allergic disorder involving increased circulating antibodies in the blood."

B (Leukemia is a neoplastic, or cancerous, disorder of blood-forming tissues that is characterized by a proliferation of immature white blood cells.)

A pediatric nurse specialist provides a teaching session to the nursing staff regarding osteogenic sarcoma. Which statement by a member of the nursing staff indicates a need for clarification of the information presented? A. "The femur is the most common site of this sarcoma." B. "The child does not experience pain at the primary tumor site." C. "Limping, if a weight-bearing limb is affected, is a clinical manifestation." D. "The symptoms of the disease in the early stage are almost always attributed to normal growing pains."

B (Osteogenic sarcoma is the most common bone cancer in children. Cancer usually is found in the metaphysis of long bones, especially in the lower extremities, with most tumors occurring in the femur (omit #1). Osteogenic sarcoma is manifested clinically by progressive, insidious, and intermittent pain at the tumor site (correct answer: #2). By the time these children receive medical attention, they may be in considerable pain from the tumor. All options: 1, 3, 4 are accurate regarding osteogenic sarcoma.)

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 (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.)

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 (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.)

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 (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.)

When assessing a child with Wilm's tumor, the nurse should keep in mind that it is most important to avoid which of the following? A. Measuring the child's chest circumference B. Palpating the child's abdomen C. Placing the child in an upright position D. Measuring the child's occipitofrontal circumference

B (The abdomen of the child with Wilm's tumor should not be palpated because of the danger of disseminating tumor cells. Children with Wilm's tumor should always be handled gently and carefully. Other answers. The child's head and chest measuring will not affect Wilm's tumor. Repositioning a child in the upright position may cause more pain to the child, but priority this is not worse than disseminating tumor cells.)

The nurse understands a primary step toward achievement of a long range goal associated with the rehabilitation of a client with a new colostomy is: A. Mastery of techniques of colostomy care B. Readiness to accept an altered body function C. Awareness of available community resources D.Knowledge of the neccessary dietary modifications.

B (The client must be ready to accept changes in body image and function; this acceptance will facilitate mastery of the techniques of colosotomy care and optimal use of community resources.)

What are the needs of the patient with acute lymphocytic leukemia and thrombocytopenia? A. To a private room so she will not infect other patients and healthcare workers. B. To a private room so she will not be infected by other patients and health care workers. C. To a semiprivate room so she will have stimulation during her hospitalization. D. To a semiprivate room so she will have the opportunity to express her feelings about her illness.

B (a-— poses little or no threat B(CORRECT:)- protects patient from exogenous bacteria, risk for developing infection from others due to depressed WBC count, alters ability to fight infection c-— should be placed in a room alone d-ensure that patient is provided with opportunities to express feelings about illness)

A child with leukemia is being discharged after beginning chemotherapy. Which of the following instructions will the nurse include when teaching the parents of this child? A. provide a diet low in protein and high in carboydrates. B. avoid fresh vegetables that are not cooked or peeled. C. notify the doctor if the child's temp exceeds 101 degrees F. D. increase the use of humidifiers throughout the house.

B (Fresh vegetables harbor microorganisms, which can cause infections in immune-compromised children, fruit or vegetables should be either peeled or cooked. The physician should be notified of a temp above 100 degrees F. A diet low in protein is not indicated. Humidifiers harbor fungi in the water containers.)

A school-age child is being seen in the oncology clinic for possible Hodgkin's disease. During the course of the nursing assessment, which findings would be expected? Select all that apply. a) fever. b) painless cervical nodes. c) painful cervical nodes. d) poor appetite. e) complaints of night sweats"

B, D (Painless cervical nodes are a hallmark sign of HD. In addition to this, night sweats also are characteristic. Fever, poor appetite, and painful cervical nodes are more characteristic of infection.")

A client is admitted to the hospital for a colon resection and in preparation for surgery the physician orders neomycin. The nurse understands the main reason why this antibiotic is especially useful before colon surgery is because it: A. Will not affect the kidneys B. Acts systemically without delay C. Has limited absorption from the GI tract. D. Is effective against many different organisms

C (Because neomycin is limited absorption form the GI tract, it exerts it antibiotic effect on the intestinal mucosa. In preparation of GI surgery, the level of microbial organisms will be reduced.)

Nursing considerations related to the administration of chemotherapeutic drugs include which of the following? a) Anaphylaxis cannot occur, since the drugs are considered toxic to normal cells. b) Infiltration will not occur unless superficial veins are used for the intravenous infusion. c) Many chemotherapeutic agents are vesicants that can cause severe cellular damage if drug infiltrates. d) Good hand washing is essential when handling chemotherapeutic drugs, but gloves are not necessary.

C (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 extravasations if necessary. a. Anaphylaxis is a possibility with some chemotherapeutic and immunologic agents. b. Infiltration and extravasations are always a risk, especially with peripheral veins. d. Gloves are worn to protect the nurse when handling the drugs, and the hands should be thoroughly washed afterward.)

A 10 year old child with hemophilia A has slipped on the ice and bumped his knee. The nurse should prepare to administer an: A. injection of factor X B. intravenous infusion of iron C. intravenous infusion of factor VIII D. intramuscular injection of iron using the Z track method

C (Hemophila refers to a group of bleeding disorders resulting from a deficiency of specific coagulation proteins. the primary meds used are to replace missing clotting factor. Factor VIII will be prescribed intravenously to replace the missing clotting factor and minimize the bleeding.)

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 (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.)

What is a characteristic manifestation of Hodgkin's Disease? A. petechiae B. erythematous rash C. enlarged lymph nodes D. pallor"

C (Knowledge of the usual pattern of spread of this lymphoma, with its orderly progression through lymph node groups and its typical forms of extranodal involvement, facilitates timely diagnosis, staging, and treatment planning.)

A patient who has been told by the health care provider that the cells in a bowel tumor are poorly differentiated asks the nurse what is meant by "poorly differentiated." Which response should the nurse make? a. "The cells in your tumor do not look very different from normal bowel cells." b. "The tumor cells have DNA that is different from your normal bowel cells." c. "Your tumor cells look more like immature fetal cells than normal bowel cells." d. "The cells in your tumor have mutated from the normal bowel cells."

C (Rationale: An undifferentiated cell has an appearance more like a stem cell or fetal cell and less like the normal cells of the organ or tissue. The DNA in cancer cells is always different from normal cells, whether the cancer cells are well differentiated or not. All tumor cells are mutations form the normal cells of the tissue.)

The goals of cancer treatment are based on the principle that A. surgery is the single most effective treatment for cancer. B. initial treatment is always directed toward cure of the cancer. C. a combination of treatment modalities is effective for controlling many cancers. D. although cancer cure is rare, quality of life can be increased with treatment modalities.

C (Rationale: The goals of cancer treatment are cure, control, and palliation. When cure is the goal, treatment is offered that is expected to have the greatest chance of disease eradication. Curative cancer therapy depends on the particular cancer being treated and may involve local therapies (i.e., surgery or irradiation) alone or in combination, with or without periods of adjunctive systemic therapy (i.e., chemotherapy).)

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.)

The postoperative care of a preschool child who has had a brain tumor removed should include which of the following? a. colorless drainage is to be expected b. analgesics are contraindicated because of altered consciousness c. positioning is on the operative side in the Trendelenberg position d. carefully monitor fluids due to cerebral edema

D (Because of cerebral edema and the danger of increased intracranial pressure postoperatively, fluids are carefully monitored. A. Colorless drainage may be leakage of cerebrospinal fluid from the incision site. This needs to be reported as soon as possible. B. Analgesics can be used for postoperative pain. C. Child should not be positioned in Trendelenburg position postoperatively.")

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 (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.)

A nurse is performing an assessment on a 10-year old child suspected having Hodgkin's disease. The nurse understands that which of the following assessment findings is characteristic of this disease? a) fever and malaise b) anorexia and weight loss c) painful, enlarged inguinal lymph nodes d) painless, firm, and movable adenopathy in the cervical area.

D (Clinical manifestations specifically associated with Hodgkin's disease include painless, firm, and movable adenopathy in the cervical and supraclavicular areas. Hepatosplenomegaly also is noted. Although fever, malaise, anorexia, and weight loss are associated with Hodgkin's disease, these manifestations are seen in many disorders.)

What assessment finding would the nurse expect to find specifically for a client admitted with Hodgkin's disease? A. Fatigue B. weakness. C. Weight gain D. Enlarged lymph nodes.

D (Enlarged lymph nodes with progression to extralymphatic sites. This is a characteristic specifically to lymphoma, where as fatigue and weakness can occur with other diseases. Weight loss is more likely than weight gain.)

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 12 year old boy seen in the clinic, and a diagnosis of Hodgkin's disease is suspected . Which diagnostic test results confirm the diagnosis of Hodgkin's disease? A . Elevated vanillylmandelic acid urinary level. B. The presence of blast cells in the bone marrow C. The presence of Epsetin-Barr virus in the blood. D. The presence of Reed-Sternberg cells in the lymph nodes

D (Hodgkin's disease is a neoplasm of lymphatic tissue. The presence of gaint multinucleated cells ( Reed- Sternbergs cells) is the hallmark of this disease. The presence of blast cells in the bone marrow indicates leukemia. The Epstein-Barr virus is associated with infectious mononucleosis . Elevated levels of vanillylmandelic acid in the urine may be found in children with neroblastoma.)

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.)

David, age 15 months, is recovering from surgery to remove Wilms' tumor. Which findings best indicates that the child is free from pain? a. Decreased appetite b. Increased heart rate c. Decreased urine output d. Increased interest in play

D (One of the most valuable clues to pain is a behavior change: A child who's pain-free likes to play. A child in pain is less likely to consume food or fluids. An increased heart rate may indicate increased pain; decreased urine output may signify dehydration.)

Which diagnostic test should be performed annually after age 50 to screen for colon cancer? a. Abdominal computed tomography (CT) b. Abdominal X-ray c. Colonoscopy d. Fecal occult blood test

D (Surface blood vessels of polyps and cancers are fragile and often bleed with the passage of stools, so a fecal occult blood test and CT scan can help establish tumor size and metastasis. A colonoscopy can help to locate a tumor as well as polyps, but is only recommended every 10 years.)

When caring for an 11-month-old infant with dehydration and metabolic acidosis, the nurse expects to see which of the following? a. A reduced white blood cell count b. A decreased platelet count c. Shallow respirations d. Tachypnea

D (The body compensates for metabolic acidosis via the respiratory system, which tries to eliminate the buffered acids by increasing alveolar ventilation through deep, rapid respirations, altered white blood cell or platelet counts are not specific signs of metabolic imbalance.)

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.)

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 (While all options can be done to encourage nutrition, allowing the preschooler choices meets two issues: nutrition and developmental tasks.)

Which condition assessed by the nurse would be an early warning sign of childhood cancer? A. difficulty swallowing B. nagging cough or hoarseness C. slight changes in bowel and bladder function D. swelling, lumps, masses on body

D (Swelling or lumps or masses anywhere on the body are early warning signs whereas difficulty swallowing or cough or hoarseness are signs of cancer in adults. there may be a marked sign in changes to bowel or bladder function, not a slight change.)

A child is diagnosed with Wilms' tumor. During assessment, the nurse in charge expects to detect: a. Gross hematuria b. Dysuria c. Nausea and vomiting d. An abdominal mass

D (The most common sign of Wilms' tumor is a painless, palpable abdominal mass, sometimes accompanied by an increase in abdominal girth. Gross hematuria is uncommon, although microscopic hematuria may be present. Dysuria is not associated with Wilms' tumor. Nausea and vomiting are rare in children with Wilms' tumor.)