Test 3: Ch 53 Malignancies PrepU
Parents ask why their child just diagnosed with leukemia needs a "spinal tap." Which is the best response by the nurse?
"Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system."
Parents tell the nurse who is admitting their infant for a well-child exam that they recently saw a "white glow" in their child's left pupil. What is the nurse's best response?
"I will report this to the pediatrician."
A 9-year-old child with leukemia is scheduled to undergo an allogenic hematopoietic stem cell transplant. When teaching the child and parents, what information would the nurse include?
"We'll need to have a match to a donor."
Children who are free of acute lymphocytic anemia for ___ years following treatment are considered cured.
4 Children who are free of disease for 4 years are considered cured, and their maintenance therapy can then be stopped.
A child is receiving chemotherapy. The chemotherapy is scheduled to begin at 10 a.m. To prevent nausea and vomiting, the child is prescribed odansetron. At what time would it be best to administer the medication?
9:30 a.m.
When reviewing information about the incidence of the various types of childhood cancer, nursing students demonstrate understanding of the information when they identify which type as having the highest incidence?
Acute lymphocytic (lymphoblastic) leukemia
The toddler with a cancer diagnosis is seen for a well-child checkup. Which health maintenance activity will the nurse exclude?
Administering the measles, mumps, rubella (MMR) vaccine Live vaccines (viral or bacterial) should not be administered to an immune suppressed child because of the risk of causing disease.
A 4-year-old child diagnosed with Wilms tumor is admitted for surgery. What information would be most important for the nurse to include in the child's preoperative plan of care?
Avoiding further abdominal palpation
A nurse is instituting neutropenic precautions for a child. What information would the nurse most likely include? Select all that apply.
Avoiding rectal exams, suppositories, and enemas Placing a mask on the child when outside the room Discouraging fresh flowers in the child's room
A group of nursing students are studying information about childhood cancers in preparation for a class examination. They are reviewing how childhood cancers differ from adult cancers. The group demonstrates understanding of the information when they identify what location as an unlikely site for childhood cancer?
Bladder
What is one advantage of an implanted port (central venous access device) that the nurse will explain to an adolescent?
Body appearance changes very little.
The nurse is admitting to an examination room a child with the diagnosis of "probable acute lymphoblastic leukemia." What will confirm this diagnosis?
Bone marrow aspiration
The nurse is caring for a child with leukemia. The parent states a variety of symptoms and the nurse identifies which symptoms as directly related to the child's cancer. Select all that apply.
Bruising Anorexia Sore throat Lymphadenopathy
How can the nurse most simply describe for distressed parents a rhabdomyosarcoma that has been found in their 5-year-old?
Call it a tumor of muscle tissue
The nurse is preparing a discharge teaching plan for the parents of an 8-year-old girl with leukemia. Which instruction would be the priority?
Calling the doctor if the child gets a sore throat
A teenage girl asks why chemotherapy causes hair loss. Which response by the nurse is accurate?
Chemotherapy affects cancer cells and normal cells that multiply rapidly.
The nurse is assessing a 10-year-old girl with acute lymphoblastic leukemia. What information would lead the nurse to suspect that the cancer has infiltrated the central nervous system?
Child reports of facial palsy and vision problems
A nurse is counseling parents of a 7-year-old boy with leukemia regarding the goals of the chemotherapy program for their son. What should she mention as the first goal?
Complete absence of leukemia cells
A child is diagnosed with rhabdomyosarcoma involving the neck. When assessing the child, what would the nurse anticipate?
Dysphagia Hoarseness Visible and palpable mass in the neck.
The nurse is caring for an 8-year-old girl who has been diagnosed with leukemia and will have a variety of tests, including a lumbar puncture, before beginning chemotherapy. What action would be the priority?
Educating the child and family about the testing procedures
The nurse caring for adolescents with cancer uses the following recommended psychosocial interventions to help the adolescents cope with their disease. Select all that apply.
Encourage adolescents to engage in their usual activities. Encourage the adolescents to make plans for the future. Control the amount of information given out about the adolescents' conditions.
The pediatric nurse examines the radiographs of a client that show that there are lesions on the bone. This finding is indicative of:
Ewing sarcoma.
The nurse explains to the teenager that which alterations may occur when steroids are added to the cancer therapy regimen?
Facial changes
Parents have just been informed that their child has a malignancy. The mother breaks down in tears, while the father appears to be in shock. What is an appropriate nursing diagnosis for this family?
Fear related to diagnosis of cancer
A preschooler who received chemotherapy in the pediatric oncology outpatient department 1 week ago now has a temperature of 101.5°F (38.6°C). Which is the most appropriate response by the nurse?
Have the parent bring the child to the pediatric oncology clinic as soon as possible. The preschooler is considered immune suppressed following recent chemotherapy. A fever can mean sepsis, which would require immediate investigation of blood and other body fluids to identify the organism, plus prompt treatment with an IV antibiotic. This can be accomplished only by seeing the pediatric oncologist and is likely to result in hospitalization.
The nurse is caring for a 5-year-old boy undergoing radiation treatment for a neuroblastoma. Which nursing diagnosis would be most applicable for this child?
Impaired skin integrity related to desquamation from cellular destruction
A child is scheduled for chemotherapy as treatment for leukemia. As the nurse is collaborating with another collegue, it is asked in which phase of the chemotherapy treatment the client is. The nurse is most correct to outline the phases as which? Place the phases in the order in which the nurse would describe from first to last.
Induction Sanctuary Delayed intensive therapy Maintenance
The nurse realizes that the chemotherapy agents and radiation that a child is receiving are likely to irritate the bladder. What are the best measures that the nurse can take to diminish this risk?
Keep intravenous (IV) fluids running to maintain excellent hydration and frequent voids
What is a well-defined risk management technique that the nurse can teach children and parents to prevent cancer?
Limit sun exposure throughout childhood and adolescence
A 12-year-old child is suspected of having Hodgkin disease. When preparing the child and family for diagnostic testing, which test would the nurse describe as being used to confirm the diagnosis?
Lymph node biopsy
A 14-year-old experiencing difficulty breathing is sent for a radiograph. The nurse knows that difficulty breathing may be indicative of:
Mediastinal mass
The nurse is planning a discussion group for parents with children who have cancer. How would the nurse describe a difference between cancer in children and adults?
Most childhood cancers affect the tissues rather than organs.
Which intervention is best to use with the 6-year-old who has developed stomatitis as a side effect of chemotherapy?
Practice frequent, gentle oral hygiene
What is the priority action the nurse should take when caring for a child newly diagnosed with Wilms tumor (nephroblastoma)?
Protect the abdomen from manipulation.
The nurse is assessing a 13-year-old girl with a family history of kidney cancer who has come to the clinic complaining of abdominal pain, nausea, and vomiting. Which finding would the nurse identify as least likely indicative of cancer in a child?
The child also reports rectal bleeding and diarrhea.
The nurse preparing clients for diagnostic testing for cancer knows that the following test is used to differentiate a neuroblastoma from other tumors:
Urine catecholamines VMA, HVA
A nurse is performing assessments during a well child visit. Which assessment is most important for screening for a malignancy?
plot and analyze height and weight
A child receiving radiation therapy has a nursing diagnosis of impaired skin integrity related to the effects of radiation therapy as manifested by erythema and dryness of the skin. Which would the nurse include in the child's plan of care? Select all that apply.
Expose the skin to air frequently. Avoid application of creams and lotions. Use mild soap to clean the skin.
The nurse identifies the nursing diagnosis of risk for infection related to chemotherapy-induced immunosuppression. What would the nurse include in the teaching plan for the child and parents about reducing the child's risk? Select all that apply.
Having the child sleep in a single bed and room Encouraging frequent, thorough handwashing
A nurse is talking with parents of a child who is to begin radiation treatment for cancer. The parents ask, "What kind of effects might we see soon after the child starts treatment?" Which effects would the nurse include when instructing the parents?
Loss of appetite Nausea Vomiting Skin redness
A 6-year-old child has been found to have a stage II brain tumor. The parent asks the nurse to explain what "stage II" means. Which information would the nurse provide?
The cancer has spread in the brain itself but the chance of complete surgical removal is good. Stage I refers to a tumor that has not extended into the surrounding tissue so can be completely removed surgically Stage II means there is some local spread but the chance for complete surgical removal is good. Stage III typically means cancer cells have spread to local lymph nodes Stage IV designates tumors that have spread systemically (metastasis).
A school nurse is teaching a group of parents about signs and symptoms of cancer in children. Which symptom is an early sign of a brain tumor?
headache, vision changes, and vomiting Children with any form of brain tumor develop symptoms of increased intracranial pressure: headache, vision changes, vomiting, an enlarging head circumference, or papilledema. Lethargy, projectile vomiting, and coma are late signs. Epistaxis is not usually related to a brain tumor. A growing tumor produces specific localized signs, such as nystagmus (constant horizontal movement of the eye) or visual field defects. As tumor growth continues, symptoms of ataxia, personality change (e.g., emotional lability, irritability), and seizures may occur. These would be later symptoms.
A 5-year-old child is at the pediatric clinic for a well-child visit. Which symptom alerts the health care provider that this child might have acute lymphocytic leukemia?
lethargy, bruises, and lymphadenopathy
A 15-year-old boy has been diagnosed with an osteogenic sarcoma of the distal femur. He also demonstrates a chronic cough, dyspnea, and chest pain, along with chronic leg pain. Based on these findings, the nurse should suspect metastasis to which body area?
Lungs
The father of an 8-year-old boy who is receiving radiation therapy is upset that his son has to go through 6 weeks of treatments. He doesn't understand why it takes so long. In explaining the need for radiation over such a long time, what should the nurse mention?
Cells are only susceptible to treatment by radiation during certain phases of the cell cycle
A child is undergoing a series of diagnostic tests for a suspected malignancy. Which diagnostic test result is only present in Hodgkin disease?
Reed Sternberg cells
