Final Exam: Oncology NCLEX Questions

What are included in nursing considerations related to the administration of chemotherapeutic drugs? a. Anaphylaxis cannot occur because 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

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

c

What is most descriptive of the therapeutic management of osteogenic sarcoma? a. Intensive irradiation is the primary treatment. b. Amputation of the affected extremity is rarely necessary. c. Treatment usually consists of surgery and chemotherapy. d. Bone marrow transplantation offers the best chance of long-term survival.

c

What pediatric oncologic emergencies are caused by the rapid release of intracellular metabolites during the initial treatment of some cancers? a. Hyperleukocytosis b. Overwhelming infection c. Acute tumor lysis syndrome d. Superior vena cava syndrome

c

Where are Wilms tumors (nephroblastomas) located? a. Bone b. Brain c. Kidney d. Lymphatic system

c

Where is the primary site of origin of the tumor in children who have neuroblastoma? a. bone b. kidney c. abdomen d. liver

c

Which of the following should be done to protect the CNS from the invasion of malignant cells in a newly diagnosed child with leukemia? a. cranial and spinal radiation b. IV steroid therapy c. intrathecal chemotherapy d. high-dose IV chemotherapy

c

A candidate for bone marrow transplantation is the child who a. is unlikely to be cured by other means b. has acute leukemia c. has chronic leukemia d. has a compatible donor in his family

a

A child with lymphoma is receiving extensive radiotherapy. What is the most common side effect of this treatment? a. Malaise b. Seizures c. Neuropathy d. Lymphadenopathy

a

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.

a

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

a

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.

a

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

a

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.

a

Neuroblastoma is often classified as a silent tumor because a. diagnosis is not usually made until after metastasis b. the primary site is intracranial c. the primary site is the bone marrow d. diagnosis is made based on the location of the primary site

a

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

a

The child who receives a bone marrow transplant will require a. meticulous personal hygiene b. multiple peripheral sites for IV therapy c. less chemotherapy before the transplant d. a room with laminar air flow

a

The most common clinical manifestation of Wilms tumor is a. painless, firm abdominal mass that does not cross the midline b. painful abdominal mass that crosses the midline c. nausea and vomiting d. anorexia

a

The nurse is administering a dose of IV vincristine when the child suddenly starts complaining of difficulty breathing and is markedly flushed. The nurse's highest priority is to a. administer an oral histamine b. stop the infusion immediately c. slow down the infusion rate d. call the practitioner

a

The nursing intervention that would be most helpful for the child who has stomatitis from cancer chemotherapy would be a. an anesthetic preparation without alcohol b. viscous lidocaine c. lemon glycerin swabs d. a mild sedative

a

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? a. clinical staging of Hodgkin disease will determine the treatment; long-term survival for all stages of Hodgkin disease is excellent b. there is a considerably better prognosis if the client is diagnosed early and less than 5 years of age c. the prognosis of Hodgkin disease depends on the type of chemotherapy d. the only way to obtain a good prognosis is by chemotherapy and bone marrow transplant

a

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

a

What are the most common signs and symptoms of leukemia related to bone marrow involvement? a. Petechiae, fever, and fatigue b. Headache, papilledema, and irritability c. Muscle wasting, weight loss, and fatigue d. Decreased intracranial pressure, psychosis, and confusion

a

What best describes a neuroblastoma? a. The diagnosis is usually made after metastasis occurs. b. It is the most common brain tumor in young children. c. Older children have an improved likelihood of survival. d. Early diagnosis is usually possible because of the obvious clinical manifestations.

a

A nurse is providing home care instructions to a parent of a child who is receiving chemotherapy. Which of the following instructions should the nurse include in the teaching? Select all that apply a. manifestations of infection b. bleeding precautions c. hand hygiene d. homeschooling e. airborne precautions

a b c

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 a. anemia b. infection c. bleeding tendencies d. bone deformities e. polycythemia

a b c

Which of the following measures should the nurse implement to help with the nausea and vomiting caused by chemotherapy? Select all that apply a. give an antiemetic 30 minutes prior to the start of therapy b. continue the antiemetic as ordered until 24 hours after the chemotherapy is complete c. remove food that has a lot of odor d. keep the child on a NPO status e. wait until the nausea begins to start the antiemetic

a b c

Which of the following can be a manifestation of leukemia in a child? Select all that apply a. leg pain b. fever c. excessive weight gain d. bruising e. enlarged lymph nodes

a b d e

A nurse is caring for a 15 year old who has just been diagnosed with non-Hodgkin lymphoma. Which of the following should the nurse include in teaching the parents about this lymphoma? Select all that apply a. the malignancy originates in the lymphoid system b. the presence of Reed-Sternberg cells in the biopsy is considered diagnostic c. mediastinal involvement is typical d. the disease is diffuse rather than nodular e. treatment includes chemotherapy and radiation

a c d e

The parents of a child with Hodgkin disease ask how the physician will know what type of cancer their child has. Which of the following definitive signs and symptoms should the nurse describe? Select all that apply a. the most common finding is enlarged, firm, nontender movable nodes in the supraclavicular or cervical area b. tests include complete blood count, prothrombin time and G6PD, erythropoetin, and sedimentation rate c. generally a bone marrow biopsy is done to look for the presence of blast cells d. the presence of Sternberg-Reed cells is considered diagnostic of Hodgkin disease e. the presence of a white reflection as opposed to the normal red pupillary reflex in the pupil is a classic sign

a d

Which of the following best describes the action of chemotherapeutic agents used in the treatment of cancer in children? Select all that apply a. suppress the function of normal lymphocytes in the immune system b. are alkylating agents and are cell-specific c. cause a replication of DNA and are cell-specific d. interrupt cell cycle, thereby causing death e. prednisone is a natural hormone

a d e

School age children with cancer often have body image disturbance related to hair loss, moon face, or debilitation. Which of the following interventions is (are) most appropriate? Select all that apply a. encourage them to wear a wig similar to their own hairstyle b. emphasize the benefits of therapy they are receiving c. have them play only with other children with cancer d. use diversional techniques to avoid discussing changes in the body because of the chemotherapy e. help them find a "special friend" who understands exactly what they are experiencing

a e

At a visit to the pediatric clinic, a mother is concerned by her 4 year old's symptoms over the last few weeks. Which of the following symptoms described by the mother would lead the nurse to be concerned about an oncologic disorder? Select all that apply a. bruising in various stages, mainly on the legs b. frequent complaints of respiratory infections, while siblings remain healthy c. enlarged, firm lymph nodes d. asthma symptoms with increase in wheezing e. fever for more than 1 week

b c e

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.

b

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

b

Children who receive reinduction therapy for a relapse of their acute lymphocytic leukemia are likely to a. recover rapidly b. receive vincristine and prednisone c. receive a bone marrow transplant d. relapse 5 years after a complete remission

b

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

b

Of the following assessment findings, the one that would most likely be seen in a child with leukemia is a. weakness of the eye muscle b. bruising, nosebleeds, pallor, and fatigue c. wheezing and shortness of breath d. abdominal swelling

b

The early signs and symptoms of brain tumor in the infant a. are similar to those of a young childs b. may be undetectable while the sutures are open c. will be demonstrated as vomiting after feedings d. will be demonstrated as headache and vomiting

b

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

b

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.

b

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 the flowers they have brought with them. Which of the following is the best response? a. "I will get you a special vase that we use on this unit" b. "The flowers from your garden are beautiful but should not be placed in the room at this time" c. "As soon as I can get a vase, I will put the flowers in it and bring it to the room" d. "Get rid of the flowers immediately. You could harm the child"

b

The nurse is caring for a child with a diagnosis of ALL who is receiving chemotherapy. The nurse notes that the child's platelet count is 20,000. Based on this finding, what information should the nurse provide to the child and parents? a. a soft toothbrush should be used for mouth care b. isolation precautions should be started immediately c. the child's vital signs, including BP, should be monitored every 4 hours d. all visitors should be discouraged from coming to see the family

b

Treatment for Ewing sarcoma usually involves a. radiation alone b. radiation and chemotherapy c. amputation and chemotherapy d. chemotherapy alone

b

When caring for a child with lymphoma, the nurse needs to be aware of which of the following? a. the same staging system is used for lymphoma and Hodgkin disease b. aggressive chemotherapy with CNS prophylaxis will give the child a good prognosis c. all children with lymphoma need a bone marrow transplant for a good prognosis d. despite high-dose chemotherapy, the prognosis is very poor for most children

b

Which of the following is the best method to prevent the spread of infection to an immunosuppressed child? a. administer antibiotics prophylactically to the child b. have people wash their hands prior to contact with the child c. assign the same nurses to care for the child each day d. limit visitors to family members only

b

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 and has never had it. Which of the following responses is most appropriate for the nurse? Select all that apply a. "you need to monitor the child's temperature frequently and call back if the temperature is greater than 101" b. "the child has had 2 varicella immunizations as an infant but is no longer immune after chemotherapy" c. "you need to bring the child to the clinic for a varicella immunoglobulin vaccine" d. "your child will need to be isolated for the next 2 weeks" e. "your child may develop chicken pox lesions about 14-21 days after exposure"

b c

Which of the following is a reason to perform a lumbar puncture on a child with a diagnosis of leukemia? Select all that apply a. rule out meningitis b. assess the CNS for infiltration c. give intrathecal chemotherapy d. determine increased intracranial pressure e. stage the leukemia

b c

The nurse taking care of a 5 year old cancer patient with ulcerative stomatitis is getting ready to perform mouth care. Which of the following principles should be followed? Select all that apply a. due to pain, viscous lidocaine should be used to swish the mouth 3 times per day b. a soft, bland diet, although not the favorite of the child, will help with the pain c. lemon glycerine swabs are helpful because they remind children of lemon drops d. using a soft sponge-type toothbrush will decrease the tendency for gums to bleed e. a solution of 1 tsp of baking soda and 1/2 tsp of table salt in 1 quart of water is helpful for mouth rinse

b d e

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 health care provider suspects that the child has ALL. The nurse informs the parent that the diagnosis will be confirmed by which of the following? a. lumbar puncture b. WBC count c. bone marrow aspirate d. bone scan

c

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

c

A nurse is caring for an adolescent who has a new diagnosis of osteosarcoma. Which of the following actions should the nurse take first? a. ensure that the adolescent has a referral for a psychiatric visit b. prepare a teaching plan to educate the adolescent in detail about the diagnosis and treatment c. spend time with the adolescent to answer any questions d. perform a mental status examination to assess the adolescent's thought patterns

c

A particular area of concern for the adolescent receiving radiotherapy is a. frequent vomiting b. altered sexual function c. high risk for sterility d. precocious puberty

c

A teen is seen in the clinic for a possible diagnosis of Hodgkin disease. The nurse is aware that which of the following symptoms should the health care provider suspect Hodgkin disease? a. Reed-Sternberg cells in the lymph nodes b. blast cells in the blood c. lymphocytes in the bone marrow d. VMA in the urine

c

An 8 year old is to receive a chemotherapeutic drug in the outpatient clinic; his mother comments that he is not eating well because he gets so nauseous with the chemo. One way to minimize these effects is to a. administer an antiemetic when the child complains of nausea b. avoid foods in the room that make him nauseous c. administer an antiemetic 30 minutes to an hour before the chemo infusion d. omit the chemo therapeutic drug from his regimen

c

Children who have profound anemia during induction therapy sohuld a. strictly limit their activities b. regulate their own activity with adult supervision c. receive blood transfusions until the hemoglobin level reaches 10 d. receive chemotherapy until the hemoglobin level reaches 10

c

Delaying vaccinations is usually recommended in the immunosuppressed child because the immune response is likely to be suboptimal; however it is considered safe to administer a. any vaccines b. any live attenuated vaccines c. any inactivated vaccines d. the varicella vaccine

c

In an attempt to prevent CNS invasion of malignant cells, children with leukemia usually receive prophylactic a. cranial-spinal irradiation b. IV steroid therapy c. intrathecal chemotherapy d. IV methotrexate and cytarabine

c

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.

c

Of the following assessment findings in the postoperative care of a child who had surgery to remove a brain tumor, the one with the most serious implications is a. a comatose child b. serosanguinous drainage on the dressing c. colorless drainage on the dressing d. decreased muscle strength

c

The nurse counsels the family of a 4 year old child that in the period immediately following remission he must a. consume a large amount of food items containing potassium to maintain adequate potassium levels b. consume a large amount of foods containing iron to replenish deleted iron stores c. wear a surgical mask and practice meticulous hand washing when going out of his house d. all of the above are important in this time period

c

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? a. administer pain medication prior to the child's going to radiation therapy b. assess the child for neuropathy since this is a common side effect c. provide adequate rest, because the child may experience excessive malaise and lack of energy d. encourage the child to eat a low-protein diet while on radiation therapy

c

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.

c

Treatment for Wilms tumor is based on clinical stage and histologic pattern an includes a. chemotherapy and radiation b. radiation alone c. surgery, chemotherapy, and radiation d. surgery alone

c

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? a. encourage low-protein foods b. encourage low-caloric foods c. offer the child's favorite foods d. offer cool, clear liquids

d

After bone marrow aspiration is performed on a child, the nurse should a. apply an adhesive bandage b. place the child in the Trendelenburg position c. ask the child to remain in the supine position d. apply a pressure bandage

d

An assessment finding that is consistent with the presence of a brain tumor is increased a. temporal headaches b. appetite c. pulse rate d. blood pressure

d

If a child vomits in the postoperative period following surgery for a brain tumor, it may predispose the child to a. incisional rupture b. increased intracranial pressure c. aspiration d. all of the above

d

Leukemia is characterized by a. a high leukocyte count b. destruction of normal cells by abnormal cells c. low numbers of blast cells d. overproduction of blast cells

d

Parents sometimes view the child's moon face from steroids as an appearance of a. an anorexic, undernourished child b. a malnourished child with a swollen abdomen c. an overweight but undernourished child d. a well nourished, healthy child

d

Prednisone is given to children who are being treated for leukemia. Why is this medication given as part of the treatment plan? a. enhances protein metabolism b. enhances sodium excretion c. increases absorption of the chemotherapy d. destroys abnormal lymphocytes

d

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 further teaching? a. "I will inspect the skin often for any lesions" b. "I will do mouth care daily and monitor for any mouth sores" c. "I will wash my hands before caring for my child" d. "I will take a rectal temperature daily and report a temperature greater than 101 immediately"

d

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

d

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)

d

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

d

What is included in the postoperative care of a preschool child who has had a brain tumor removed? a. Colorless drainage is to be expected. b. Analgesics are contraindicated because of altered consciousness. c. Positioning is on the operative side in the Trendelenburg position. d. Carefully monitor fluids because of cerebral edema.

d

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

d

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

d

Which intervention should be implemented after a bone marrow aspiration? a. ask the child to remain in a supine position b. place the child in an upright position for 4 hours c. keep the child NPO for 6 hours d. administer analgesics as needed for pain

d