341 - pediatrics

Question: The child has been diagnosed with leukemia. Rank the following medications used to treat leukemia in order based on the stage of treatment. 1 High-dose methotrexate and 6-mercaptopurine 2 Chemotherapy through an intrathecal catheter 3 Oral steroids and vincristine through an intravenous line 4 Low doses of 6-mercaptopurine and methotrexate

3, 1, 4, 2: During induction, the child receives oral steroids and IV vincristine. During consolidation, the child receives high doses of methotrexate and 6-mercaptopurine. During maintenance, the child receives low doses of methotrexate and 6-mercaptopurine. During central nervous system prophylaxis, the child receives intrathecal chemotherapy

Question: Put the following phases of the cell cycle in correct order: 1 Cell at rest 2 DNA stabilization 3 Cell doubles in size 4 Mitosis: cell division 5 Synthesis: duplication of DNA and chromosomes 6 Gap

Gap Cell at rest DNA stabilization Synthesis: duplication of DNA and chromosomes Cell doubles in size Mitosis: cell division The phases of the cell cycle are as follows: 1) Gap, 2) cell at rest, 3) DNA stabilization, 4) synthesis: duplication of DNA and chromosomes, 5) cell doubles in size, and 6) mitosis: cell division

Nursing students are reviewing information about the normal cell cycle. They demonstrate understanding of this process when placing phases in the proper sequence. Place the phases in the sequence that demonstrates understanding by the nursing students. 1 Cell at rest 2 Period until DNA stabilization complete 3 Cell division 4 Duplication of DNA and chromosomes 5 Doubling of cell size 6 Gap

Gap Cell at rest Period until DNA stabilization complete Duplication of DNA and chromosomes Doubling of cell size Cell division The phases of the cell cycle include G or gap phase; G0 when the cell is at rest; G1, the period until DNA stabilization is complete; S(synthesis), DNA and chromosomes duplicate or cell readies for division; G2, the cell doubles in size in preparation for dividing; and mitosis or period of cell division

Parents bring their daughter to the health care facility for evaluation. They report that lately the child seems rather pale and really tired. What would the nurse most likely find with further assessment if the child has acute lymphoblastic leukemia (ALL)? Select all that apply. a) Low-grade fever b) Painless cervical lymphadenopathy c) Bleeding from the oral mucous membranes d) Headache e) Chest painChest pain

a, b, c, d: Assessment findings associated with ALL include low-grade fever, lethargy, petechiae, bleeding from the oral mucous membranes, and easy bruising. As the spleen and liver begin to enlarge, abdominal pain, vomiting, and anorexia occur. Physical assessment reveals painless, generalized swelling of lymph nodes, especially the submaxillary or cervical nodes. (less)

The child has been diagnosed with cancer and is being treated with chemotherapy. Which findings are common side effects of this type of treatment? Select all that apply. a) The child's mother states, "It seems like he catches every bug that comes along." b) The child reports feeling nauseated. c) The child's mother states that she often has to repeat herself because he can't hear very well. d) The child has no hair on his head. e) The child's teeth are enlarged.

a, b, c, d: Common adverse effects of chemotherapeutic drugs are: immunosuppression, alopecia, hearing changes, and nausea. Another common adverse effect is microdontia, not enlarged teeth

A young school-age child who is being treated for cancer has constipation and loss of appetite. What nursing interventions should the nurse suggest to the family? Choose all that apply. a) Provide adequate private time in the bathroom. b) Add high-fiber snacks such as popcorn and apples to the diet. c) Increase gross motor activities such as family walks. d) Use a rectal suppository at the same time each day.

a, b, c: Fiber in the diet promotes bowel emptying. Even with decreased appetite, popcorn and apples are likely to be accepted. A simple gross motor activity such as walking stimulates peristalsis. Adequate private bathroom time will promote evacuation in the school-age child who is sensitive about bodily functions. Suppositories are avoided to prvent damage to the rectal mucosa.

A nurse is assessing a child with cancer and suspects that the child has developed sepsis based on what findings? Select all that apply. a) Hyperkalemia b) Absolute neutrophil count (ANC) less than 500 c) Respiratory alkalosis d) Increased blood urea nitrogen (BUN) e) Thrombocytosis

a, b, d: Findings associated with sepsis include ANC less than 500, increased BUN, increased potassium, decreased platelets, and metabolic acidosis.

What signs and symptoms has the elementary school nurse noted that create suspicion of a brain tumor in a student? Select all that apply. a) Nausea and vomiting b) Clumsiness in movement c) Reddened sclera d) Ringing in the ears e) Headache on awakening

a, b, e: Most brain tumors in children occur in the cerebellum or brain stem, so that initial symptoms are those of increased intracranial pressure (ICP). Incoordination is also a frequent sign. Ringing in the ears and reddened sclera do not create suspicion of a brain tumor

The nurse is assessing a 2-year-old girl whose parents noticed that one of her pupils appeared to be white. Which assessments should the nurse expect to find if the girl has retinoblastoma? Select all that apply. a) Assessment discloses hyphema in one eye. b) Observation of eyes reveals yellow discharge. c) History reveals strabismus. d) Observation confirms cat's eye reflex in pupil. e) Parents report that the child has headaches.

a, c, d, e: Observation revealing a thick, yellow discharge is typical of infectious conjunctivitis, not retinoblastoma. Headaches and hyphema, a collection of blood in the anterior chamber of the eye, are associated with retinoblastoma as is leukocoria, "cat's eye reflex." Health history reveals associated symptoms, including stabismus

The nurse is teaching a group of 13-year-old boys and girls about screening and prevention of reproductive cancers. Which subjects would not be included in the nurse's teaching plan? Select all that apply. a) Sexually transmitted disease is a risk factor for cervical cancer. b) Testicular cancer is one of the most difficult cancers to cure. c) A papanicolaou (PAP) smear does not require parent consent in most states. d) Provide information regarding the benefits of receiving the HPV vaccine. e) Self-examination is an effective screening method for testicular cancer.

a, c, d, e: Telling the group that testicular cancer is one of the most difficult cancers to cure would not be part of the teaching plan. It would be more accurate and appropriate for the nurse to stress that testicular cancer is one of the most curable cancers if diagnosed early. Self-examination is an excellent way to screen for the disease. Girls should know that they can take responsibility for their own sexual health by getting a PAP smear. All the children should understand that early intercourse, sexually transmitted infections (STIs), and multiple sex partners are risk factors for reproductive cancer. Information should be provided so the teen girls can discuss the benefits of receiving the human papilloma virus vaccine since many cervical cancers are attributed to human papillomavirus

The nurse caring for a child with leukemia documents which signs as clinical or diagnostic features of the disease. Select all answers that apply. a) Anorexia b) Increased platelet count c) Lymphadenopathy d) Sore throat e) Increased hemoglobin f) Bruising

a, c, d, f: Clinical and diagnostic features of leukemia include fatigue, weakness, pallor, fever, bruising, bleeding (e.g., petechiae or purpura), weight loss, anorexia, swollen gums, sore throat, recurrent infections, flu-like symptoms, abdominal pain, nausea, vomiting, bone pain, lymphadenopathy, splenomegaly, hepatosplenomegaly, elevated leukocyte count (mm3), decreased hemoglobin (g/dL), and decreased platelets

A nurse is preparing a presentation for a parent group on childhood cancers. As part of the presentation, the nurse plans to discuss rhabdomyosarcoma. What are some common sites where rhabdomyosarcoma occurs? Select all that apply. a) Neck b) Central nervous system c) Extremities d) Gastrointestinal tract e) Head

a, c, d: The most common locations for rhabdomyosarcoma are the head and neck, genitourinary tract, and extremities.

A child is receiving chemotherapy and develops stomatitis. The nurse identifies a nursing diagnosis of impaired oral mucous membranes related to the effects of chemotherapy. What instructions would the nurse include in the child's plan of care? Select all that apply. a) Have the child rinse the mouth with lukewarm water three times a day. b) Give the child acidic foods (e.g., orange juice) to cleanse the mouth. c) Vigorously rub the child's gums with gauze to clean them. d) Provide various soft and bland foods to minimize further irritation. e) Apply a lip balm or petroleum jelly to prevent cracking.

a, d, e: For the child with stomatitis, the nurse should provide soft foods to prevent further abrasions, have the child rinse the mouth three times a day with lukewarm water to promote comfort and healing, avoid giving the child acidic foods that would further irritate the tissue, and apply a lip balm or petroleum jelly to prevent cracking of the lips. The nurse should offer a soft toothbrush to minimize discomfort

The nurse caring for adolescents with cancer uses the following recommended psychosocial interventions to help the adolescents cope with their disease. Select all answers that apply. a) Control the amount of information given out about the adolescents' conditions. b) Be an advisor, not a friend to the adolescents to promote cooperation in the care plan. c) Postpone return to school for as long as possible to ensure eventual successful return. d) Discourage relationships with other adolescents who have cancer. e) Encourage the adolescents to make plans for the future. f) Encourage adolescents to engage in their usual activities.

a, e,f: The nurse should encourage usual activities and plans for the future and control the amount of information outsiders know about the child's condition. Relationships with other children with cancer should be encouraged as well as an early return to school. The nurse should be a friend as well as an advisor to the adolescents

How can the nurse most simply describe for distressed parents a rhabdomyosarcoma that has been found in their 5-year-old? a) Call it a tumor of muscle tissue b) Explain that it develops in nerves outside the brain and spinal cord c) Indicate that the more commonly used name is Hodgkin's disease d) Describe it as a bone tumor

a: A rhabdomyosarcoma is a tumor of striated muscle that most commonly develops in the head, neck, arms, and legs, as well as in the genitourinary tract, of children. The other descriptors are incorrect

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? a) Acute lymphocytic (lymphoblastic) leukemia b) Neuroblastoma c) Osteogenic sarcoma d) Non-Hodgkin's lymphoma

a: Acute lymphocytic leukemia accounts for approximately 32% of all childhood cancers. Neuroblastomas account for 8%; non-Hodgkin's lymphoma accounts for 6%; osteogenic sarcoma accounts for 3%.

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? a) Avoiding further abdominal palpation b) Performing dressing changes to the affected area c) Preparing the child for amputation d) Administering analgesics for pain

a: After the initial assessment is performed on a child with Wilms tumor, further palpation of the abdomen should be avoided because the tumor is highly vascular and soft. Therefore, excessive handling of the tumor may result in tumor seeding and metastasis. Preoperatively, the child with Wilms tumor does not have a wound; therefore, dressing changes are not necessary. Although the child may experience abdominal pain, avoiding further abdominal palpation would be the priority. Surgical removal of the tumor and affected kidney is the treatment of choice for Wilms tumor. Amputation would be more likely for a child with osteosarcoma.

What would the nurse expect to be ordered for a child with acute lymphoblastic leukemia who develops tumor lysis syndrome? a) Allopurinol b) Inotropics c) Dexamethasone d) Leukapheresis

a: Allopurinol is used to prevent and treat tumor lysis syndrome. For prevention, the drug is given for several days prior to chemotherapy. Inotropics would be used to treat sepsis. Leukapheresis would be used to treat leukemia with a high white blood cell count. Dexamethasone would be used to treat spinal cord compression and/or increased intracranial pressure secondary to the tumor or metastasis

The nurse will use a special needle to start intravenous (IV) fluids through which central venous access device? a) An implanted port b) A multilumen catheter c) A peripherally inserted central catheter d) A tunneled central catheter

a: An implanted port requires a special (Huber) needle placed through the skin into the port, which is implanted surgically under the skin and over a bony prominence. The peripherally inserted central catheter (PICC) and tunneled catheters (Broviac, Hickman, Groshong) do not require a special needle for access. A multilumen catheter has more than one lumen but is not a port.

When explaining the procedure of bone marrow aspiration to a child with leukemia, what would be the best explanation? a) "You will feel pressure on your hip from the needle." b) "You will have to lie on your back and hold your breath." c) "You will need to lie still afterward to prevent a headache." d) "You won't feel any pain at all, because you will be asleep."

a: Bone marrow aspiration requires hard pressure to allow the needle to puncture the bone. It is usually done under local anesthesia or conscious sedation.

Children who are free of acute lymphocytic anemia for 2 years following treatment are considered cured. a) False b) True

a: Children who are free of disease for 4 years are considered cured, and their maintenance therapy can then be stopped.

The nurse is caring for a 4-year-old boy following surgical removal of a stage I neuroblastoma. Which intervention is most appropriate for this child? a) Giving medications as ordered via least invasive route b) Administering antiemetics as prescribed for nausea c) Applying aloe vera lotion to irradiated areas of skin d) Maintaining isolation as prescribed to avoid infection

a: Giving medications as ordered using the least invasive route is a postsurgery intervention focused on providing atraumatic care and is appropriate for this child. Since the child has a stage I tumor, it can be treated by surgical removal, and does not require chemotherapy or radiation therapy. Applying aloe vera lotion is good skin care following radiation therapy. Administering antiemetics and maintaining isolation are interventions used to treat side effects of chemotherapy

Children with ALL may need periodic lumbar punctures. You would teach the mother this is done to assess for: a) leukemic cells. b) early meningitis. c) early development of septicemia. d) platelets.

a: Leukemic cells in cerebrospinal fluid must be identified because, if present, they require additional therapy.

What is a well-defined risk management technique that the nurse can teach children and parents to prevent cancer? a) Limit sun exposure throughout childhood and adolescence b) Avoid artificial colors, flavors, and fragrances in foods, cosmetics, and household items c) Eliminate aerosol sprays from the living area d) Incorporate more preservative-free foods into the diet

a: Limiting sun exposure by using shade, clothing, and sunscreen applied correctly will reduce the risk of skin cancer. Sun exposure is cumulative throughout life; the greatest exposure tends to occur in childhood and adolescence. Tanning booths should not be used. The other choices could have some merit, but none has been scientifically confirmed

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? a) Lungs b) Heart c) Rib cage d) Brain

a: Metastasis occurs early with bone tumors because of the extensive vascular system in bones. Metastasis to the lungs is very common; as many as 25% of adolescents will have lung metastasis already by the time of initial diagnosis. When this is present, the adolescent usually has noticed a chronic cough, dyspnea, and chest pain in addition to chronic leg pain. Other common sites of metastasis are brain and other bone tissue.

The pediatric nurse examines the radiographs of a client that show that there are lesions on the bone. This finding is indicative of: a) Ewing sarcoma. b) Hodgkin disease c) non-Hodgkin lymphoma. d) neuroblastoma.

a: Radiographs that show lesions on the bone may indicate tumors (e.g., Ewing sarcoma, osteosarcoma) or metastasis of tumors and warrant further investigation by bone scan, CT, or MRI. Positron emission tomography is the most effective test to diagnose Hodgkin disease, non-Hodgkin lymphoma, a neuroblastoma, bone tumors, lung and colon cancers, and brain tumors

During a physical examination of a 13-year-old boy, the nurse observes a single, enlarged, rubbery-feeling cervical lymph node in the armpit. The boy also reports unexplained loss of weight and malaise. Which condition should the nurse most suspect in this client? a) Hodgkin lymphoma b) Acute myeloid leukemia (AML) c) Acute lymphocytic leukemia (ALL) d) Non-Hodgkin lymphoma

a: Symptoms of Hodgkin disease usually begin with the enlargement of only one painless, enlarged, rubbery-feeling cervical lymph node. Other nodes then become involved, along with the liver, spleen, bone marrow, and, eventually, the central nervous system. The child usually reports accompanying symptoms of anorexia, malaise, night sweats, and loss of weight. Fever may be present. Non-Hodgkin's lymphomas tend to involve the lymph glands of the neck and chest most commonly, although axillary, abdominal, or inguinal nodes may be the first involved. If mediastinal lymph glands are swollen, the child may notice a cough or chest "tightness." Because mediastinal nodes press on the veins returning blood from the head, edema of the face may result. The first symptoms of ALL in children usually are those associated with decreased RBC production (anemia) such as pallor, low-grade fever, and lethargy. Children with AML have the same symptoms as those with ALL

The nurse must calculte the absolute neutophil count for an immune suppressed child. Which is the accurate ANC based on the following laboratory results? Total white blood cell count (WBC): 3000. WBC differential: 10% segmented neutrophils, 8% neutrophil bands. a) 540 b) 300 c) 60 d) 240

a: The ANC is not measured directly; it must be calculated. Step 1: Determine the total percentage of neutrophils. 10% + 8% = 18% (0.18) Step 2: Multiply the WBC by the total percent of neutrophils. 3000 X 0.18 = 540 ANC

The nurse caring for a 14-year-old scheduled for magnetic resonance imaging (MRI) explains how the test works to the family. Which response accurately describes this test? a) "The MRI uses radio waves and magnets to produce a computerized image of the body." b) "The MRI is a nuclear scanning test to rule out cancer involving the bones or determine extent of bone involvement." c) "The MRI uses radiation to examine soft tissue and bony structures of the body."

a: The MRI uses radio waves and magnets to produce a computerized image of the body. The bone scan is a nuclear scanning test to rule out cancer involving the bones or determine extent of bone involvement. The ultrasound uses sound waves to create images that visualize body structures and locate masses. Radiography uses radiation to examine soft tissue and bony structures of the body

The nurse is caring for a 6-year-old boy with non-Hodgkin lymphoma who is being treated with monoclonal antibodies. What recommendation would the nurse include in the child's plan of care? a) Monitoring for allergic reactions or anaphylaxis b) Assessing for signs of capillary leak syndrome c) Monitoring for complaints of bone pain d) Assessing the child's hydration status secondary to vomiting

a: The nurse would monitor for infusion-related reactions and anaphylaxis if monoclonal antibodies were administered and would have epinephrine, antihistamines, and steroids available at the bedside for treatment if a reaction occurred. Assessing the level of hydration due to vomiting would be necessary if tumor necrosis factor was administered. The flu-like symptoms produced by interferons require hydration maintenance also. Monitoring for complaints of bone pain is appropriate when administering colony-stimulating factors such as filgrastim or sargramostim. Assessing for signs of capillary leak syndrome within 2 to 12 hours of the start of treatment is necessary when interleukins are used

The nurse is providing preoperative care for a 7-year-old boy with a brain tumor and his parents. Which intervention is priority? a) Assessing the child's level of consciousness b) Having the child talk to another child who has had this surgery c) Providing a tour of the intensive care unit d) Educating the child and parents about shunts

a: The priority intervention is to monitor for increases in intracranial pressure because brain tumors may block cerebral fluid flow or cause edema in the brain. A change in the level of consciousness is just one of several subtle changes that can occur indicating a change in intracranial pressure. Lower priority interventions include providing a tour of the ICU to prepare the child and parents for after the surgery, and educating the child and parents about shunts.

A cancer patient is diagnosed with typhitis. Which one of the following is a recommended emergency intervention when this condition occurs? a) Administer broad-spectrum antibiotics intravenously. b) Maintain fluid restriction to below maintenance levels. c) Administer diuretics. d) Monitor serum sodium levels.

a: The recommended interventions for typhitis are: administer broad-spectrum antibiotics intravenously, provide supportive care to manage symptoms, and anticipate surgical intervention to remove area of inflammation or infarct if necessary.

A child undergoing chemotherapy for leukemia is receiving methotrexate as part of maintenance therapy. What would the nurse expect to be prescribed to assist in counteracting the effects of this drug? a) Leucovorin b) Cisplatin c) Prednisone d) Vincristine

a: To counteract the systemic effects of methotrexate and protect normal cells from its effects, leucovorin is usually administered. Vincristine and prednisone may be used as part of maintenance therapy and have no effect on counteracting the effects of methotrexate. Cisplatin may be used as treatment for many different types of cancer but has no effect on counteracting methotrexate

The mother of an 11-year-old girl who will begin radiation therapy soon asks the nurse what the family needs to do for their daughter during this time. Which interventions should the nurse mention? Select all that apply. a) Increase amounts of fresh fruit and vegetables rich in cellulose b) Expose the irradiated area to air c) Apply skin creams and lotions to irradiated skin d) Encourage lengthy soaks in the bath e) Administer antiemetics as prescribed f) Help the child devise "mind games" to play during the procedure

b, e, f: To care for the child who is receiving radiation therapy, the family should expose irradiated area to air but not to direct heat or sunlight, administer antiemetics as prescribed, and help the child devise "mind games" to play during the procedure, among other things. Because some skin preparations are drying and some interfere with radiation, do not apply creams or lotions unless prescribed. Avoid lengthy soaks in bath water or swimming pools. Reduce amounts of fresh fruit and vegetables rich in cellulose, and eliminate apple juice from the child's diet, because these may contribute to diarrhea and subsequent fluid loss

A child is diagnosed with rhabdomyosarcoma involving the neck. When assessing the child, what would the nurse expect to find? Select all that apply. a) Proptosis b) Hoarseness c) Hearing loss d) Facial nerve palsy e) Dysphagia

b, e: With rhabdomyosarcoma involving the neck, assessment findings would include hoarseness, dysphagia, and a visible and palpable mass in the neck. Proptosis would be noted if the site of the tumor is the orbit. Hearing loss and facial nerve palsy suggest middle ear involvement.

The nurse is providing care to a child and is to collect a 24-hour urine specimen for catecholamines. The nurse integrates knowledge of this testing as indicative of: a) osteosarcoma. b) neuroblastoma. c) Hodgkin disease. d) leukemia.

b: A 24-hour urine specimen for catecholamines (homovanillic acid [HVA] and vanillylmandelic acid [VMA]) is used to help diagnose neuroblastoma because this cancer produces catecholamines; thus, levels will be elevated. This test is not used to diagnose Hodgkin disease, leukemia, or osteosarcoma

The nurse is assessing a 4-year-old girl whose mother reports that she is not eating well, is losing weight, and has started vomiting after eating. Which risk factor from the health history suggests the child may have a Wilms tumor? a) The child has Schwachman syndrome. b) The child has Beckwith-Wiedemann syndrome. c) The child has Down syndrome. d) There is a family history of neurofibromatosis

b: Along with the symptoms reported by the mother, the fact that the child has Beckwith-Wiedemann syndrome suggests that the child could have a Wilms tumor. Down syndrome would point to leukemia or brain tumor. Schwachman syndrome would suggest leukemia. A family history of neurofibromatosis is a risk factor for brain tumor, rhabdomyosarcoma, or acute myelogenous leukemia

A nursing student compares and contrasts childhood and adult cancers. Which statement does so accurately? a) Little is known regarding cancer prevention in adults, although much prevention information is available for children. b) Children's cancers, unlike those of adults, often are detected accidentally, not through screening. c) Adult cancers are more responsive to treatment than are those in children. d) Environmental and lifestyle influences in children are strong, unlike those in adults.

b: Children's cancers are often found during a routine checkup, following an injury, or when symptoms appear---not through screening procedures or other specific detection practices. A very small percentage of children may be followed closely because they are known to be at high risk genetically. Most children's cancers are highly responsive to therapy. Few prevention strategies are available for children, although many are known to be effective for adults. Several lifestyle and environmental influences regarding children's cancers are suspect, but few have been scientifically documented. The reverse is true in the adult population

The nurse is assessing a 3-year-old boy whose mother reports that he is listless and has been having trouble swallowing. Which finding suggests the child may have a brain tumor? a) Observation reveals a cough and labored breathing b) Observation reveals nystagmus and head tilt c) Examination shows temperature of 101.4° F (38.6°C) and headache d) Vital signs show blood pressure measures 120/80 mm Hg

b: Coupled with the mother's reports, observation of nystagmus and head tilt suggest the child may have a brain tumor. Elevated blood pressure of 120/80 mm Hg may be indicative of Wilms tumor. Fever and headaches are common symptoms of acute lymphoblastic leukemia. A cough and labored breathing points to rhabdomyosarcoma near the child's airway

A 14-year-old experiencing difficulty breathing is sent for a radiograph. The nurse knows that difficulty breathing may be indicative of: a) Lymphadenopathy b) Mediastinal mass c) Retinoblastoma d) Tumor in the liver

b: Difficulty breathing or respiratory distress may indicate a mediastinal mass (which may be seen on a radiograph). Presence of a white reflection in the pupil of the eye may indicate retinoblastoma. Enlarged or tender axillary lymph nodes may indicate lymphadenopathy. Hepatomegaly or splenomegaly may be caused by an infection or tumor in the liver or abdomen

A child receiving chemotherapy is experiencing significant reduction in red blood cells secondary to myelosuppression. Which agent would the nurse most likely expect to be ordered? a) Filgrastim b) Epoetin alfa c) Sargramostim d) Gamma interferon

b: Epoetin alfa is a colony-stimulating factor used to stimulate production of red blood cells. Filgrastim is a colony-stimulating factor used to stimulate production of granulocytes. Sargramostim is a colony-stimulating factor used to stimulate production of granulocytes. Gamma interferon is used to stimulate macrophage production to fight bacteria and fungus

The nurse is educating the parents of a 16-year-old boy who has just been diagnosed with Hodgkin disease. Which discussion is most appropriate at this time? a) Telling about the drugs and side effects of chemotherapy b) Describing the two ways of staging the disease c) Explaining how to care for skin after radiation therapy d) Informing the parents about postoperative care

b: It would not be necessary for the nurse to inform the parents about postoperative care since this is not a treatment method for the disease. The treatment of choice for Hodgkin disease is chemotherapy, but radiation therapy may be necessary; however, discussing the treatment methods may be overwhelming at this time. Upon first learning the diagnosis, it is most helpful for the nurse to explain that staging refers to the spread of the disease (stages I through IV); and that A means the child is asymptomatic, while B means that symptoms are present

A 6-year-old girl has been found to have a brain tumor. The oncologist has told the girl's parents that the tumor is stage II. Later, the girl's mother asks the nurse to explain what "stage II" means. Which of the following should the nurse mention? a) Cancer cells have spread to local lymph nodes b) The cancer has spread some in the brain itself but the chance of complete surgical removal is good c) Tumors have spread systematically throughout the body d) The tumor has not extended into the surrounding tissue and so can be completely removed surgically

b: Knowing the stage of a tumor helps the health care team design an effective treatment program, establish an accurate prognosis, and evaluate the progress or regression of the disease. In general, 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).

The toddler with a cancer diagnosis is seen for a well-child checkup. Which health maintenance activity will the nurse exclude? a) Plotting height and weight on a growth chart b) Administering the measles, mumps, rubella (MMR) vaccine c) Teaching the importance of taking water safety measures d) Assessing dietary intake by addressing "picky eating" and "food jags"

b: Live vaccines (viral or bacterial) should not be administered to an immune suppressed child because of the risk of causing disease. The other health maintenance activities are important for the health maintenance of the toddler and should be included during the well-child visit

The nurse is assessing an adolescent with suspected osteosarcoma. What would the nurse be least likely to assess? a) Erythema of the extremity b) Severe bone pain c) Gait changes d) Swelling of the extremity

b: Osteosarcoma typically is characterized by dull bone pain that may be present for several months, eventually progressing to limp or gait changes. The affected limb may exhibit erythema and swelling, warmth, and tenderness

Parents ask why their child is receiving prednisone to treat leukemia, because it is not a chemotherapy drug. How should the nurse answer? a) "The drug will stimulate the child's appetite." b) "Prednisone decreases edema cause by tumor necrosis." c) "Prednisone is excellent for reducing inflammation." d) "The medication will promote weight gain."

b: Prednisone is not a chemotherapeutic agent, but a hormone and it is given in conjunction with chemotherapy to decrease edema caused by tumor necrosis or the tumor. Reducing inflammation, stimulating appetite, and promoting weight gain are some actions and possible side effects of prednisone but do not provide the reason why the medication is used to treat leukemia

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? a) Insurance companies typically allow only a short radiation treatment per week, to contain costs b) Cells are only susceptible to treatment by radiation during certain phases of the cell cycle c) It is difficult to locate where the cancer cells are in the body, so the entire body must be irradiated d) Radiation therapy is very weak, and therefore it takes a long time to achieve therapeutic doses

b: Radiation is not effective on cells that have a low oxygen content (a proportion of cells in every tumor), nor is it effective at the time of cell division (mitosis). Therefore, radiation schedules are designed so that therapy occurs over a period of 1 to 6 weeks and includes time intervals when cells will be in a susceptible stage

A child is to receive radiation therapy this morning. The nurse would expect to see which type of drug prescribed to this child? a) Antipyretic b) Antiemetic c) Analgesic d) Antineoplastic

b: Radiation therapy causes nausea because it destroys rapid-growing cells. Among these are the cells of the stomach lining, the reason that nausea occurs.

The parent of a child with Down syndrome phones the Nurse Line to report three weeks of lack of energy, limping, and weight loss in the young child. What is the most appropriate advice? a) "Give an age-appropriate dose of acetaminophen every 4 hours." b) "Bring the child to pediatrics to be examined." c) "Limit active play, and offer frequent small snacks and meals." d) "If symptoms persist, have the child seen within 7 days."

b: Symptoms could indicate acute lymphoblastic leukemia (ALL). Compared with other children, children with Down syndrome have 15 times the risk of developing ALL.

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? a) "Has your baby been rubbing either eye?" b) "I will report this to the pediatrician." c) "Most parents mention a red color." d) "A plugged tear duct would not be unusual."

b: The "white glow" may indicate retinoblastoma; immediate investigation is needed. The red reflex is indicative of eye health. Eye rubbing and a plugged tear duct are unrelated to the symptom described

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? a) Noting adventitious breath sounds during auscultation b) Child reports of facial palsy and vision problems c) Observing petechiae, purpura, or unusual bruising d) Palpation of abdomen reveals enlarged liver and spleen

b: The presence of facial palsy and vision problems indicates that the central nervous system has been infiltrated by leukemia cells. The petechiae, purpura, or unusual bruising results from decreased platelet levels and may be present regardless of metastasis. Adventitious breath sounds may indicate pneumonia, and may be present whether the disease has metastasized or not. Hepatomegaly and splenomegaly result from infection, not metastasis

A high-school football player has been diagnosed as having osteosarcoma of the femur. His mother is angry because she told him not to play football. Which health teaching points would you include in the teaching plan for the boy and his mother? a) He can expect some discoloration of his leg following chemotherapy. b) Football injuries do not contribute to the development of a tumor. c) Osteosarcoma often follows trauma, such as a football injury. d) Tumor growth is more related to his dislike of milk.

b: Trauma does not contribute to developing bone cancer; a lesion may be discovered after a traumatic injury

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. a) Cheering up the environment with fresh flowers and plants b) Encouraging frequent close contact with numerous visitors c) Encouraging frequent, thorough handwashing d) Providing a low-carbohydrate, low-protein diet e) Having the child sleep in a single bed and room

c, e: To reduce the risk of infection, the nurse should teach the child and parents about minimizing the child's exposure to potentially infectious situations. The nurse should encourage the parents to arrange for the child to sleep in a single bed and room and, if possible, avoid close contact with other family members who may be developing upper respiratory tract infections. Thorough and frequent handwashing, especially after using the bathroom and before eating, is essential. A high-calorie, high-protein diet helps to rebuild white blood cells and should be encouraged. If possible, the child's exposure to large crowds and visitors should be limited because of the increased risk of infection from these individuals. Fresh flowers and plants should be avoided because they could harbor mold spores

The child has been admitted to the hospital. Her absolute neutrophil count is 450 and the child has been placed in neutropenic precautions. Which of the following nursing interventions indicates that the nurse requires further education? Select all that apply. a) The nurse carefully washes his hands before and after providing care for the child b) The nurse monitors the child's vital signs every 2 to 4 hours c) The child is being transported to radiology for an X-ray and the nurse places gloves on the child's hands d) The child has been placed in a semiprivate room e) The nurse assesses the child for clinical manifestations of an infection every 4 to 8 hours

c. d: The child in neutropenic precautions should be placed in a private room. Prior to transportation to other areas of the hospital, the nurse should place a mask on the child before she leaves her room. The nurse should monitor the child's vital signs at least every 4 hours. The nurse should carefully assess for signs and symptoms of infection at least every 8 hours. The nurse should perform hand hygiene before and after contact with each child

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? a) Osteogenic sarcoma b) Non-Hodgkin's lymphoma c) Acute lymphocytic (lymphoblastic) leukemia d) Neuroblastoma

c: Acute lymphocytic leukemia accounts for approximately 32% of all childhood cancers. Neuroblastomas account for 8%; non-Hodgkin's lymphoma accounts for 6%; osteogenic sarcoma accounts for 3%

The physician orders an alkylating agent for a child's chemotherapy. Which best describes an action produced by these types of agents? a) They are most active in the S phase and act similarly to normal cellular metabolites necessary for cell replication. b) They damage cells by acting as a substitute for a natural metabolite in an important molecule. c) They are cell cycle-nonspecific, destroying both resting and dividing cells. d) They are synthesized naturally by various bacterial and fungal agents.

c: Alkylating agents are cell cycle-nonspecific, destroying both resting and dividing cells. During alkylation, the hydrogen atoms of some molecules within the cell are replaced by an alkyl group. This group interferes with DNA replication and RNA transcription

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? a) "You'll need to have an incision in your hip area to instill the cells." b) "The risk for rejection is much less with this type of transplant." c) "We'll need to have a match to a donor." d) "You won't need to receive the high doses of chemotherapy before the transplant."

c: An allogenic hematopoietic stem cell transplantation (HSCT) refers to transplantation using stem cells from another individual that are harvested from the bone marrow, peripheral blood, or umbilical cord blood. With this type of transplant, human leukocyte antibody (HLA) matching must occur. Therefore, the lesser the degree of HLA matching in the donor, the higher the risk for graft rejection and graft-versus-host disease (GVHD). Regardless of the type of transplant, a period of purging of abnormal cells in the child is necessary and accomplished through high-dose chemotherapy or irradiation. The procedure is accomplished by intravenously infusing hematopoietic stem cells into the child.

What is one advantage of an implanted port (central venous access device) that the nurse will explain to an adolescent? a) No tunneling is needed when the port is inserted. b) No special procedure is necessary for removal. c) Body appearance changes very little. d) Flushing of the device is not necessary.

c: An implanted port has nothing extending through the skin and may be obvious only as a slight protrusion at the insertion site. Some tunneling from the port to a central vein is needed. Removal of the port requires a surgical procedure. Flushing of the port is necessary when used and on a regular basis

Antiemetics are ordered to control nausea and vomiting in the child undergoing chemotherapy. How can the nurse most effectively use these medications? a) Provide the antiemetic as needed (PRN) when nausea and vomiting are reported b) Start the antiemetic on a scheduled basis when the chemotherapy begins to cause nausea c) Administer the antiemetic before starting chemotherapy d) Use the antiemetic after it is clear that nonpharmacologic methods are not effective

c: Antiemetics are most effective when given before chemotherapy begins and then on a regular schedule to prevent nausea and vomiting throughout administration of chemotherapy. Nonpharmacologic measures can be used in conjunction with antiemetics but not in place of them

An important nursing intervention to institute with an infant prior to surgery for a Wilms' tumor is to place a sign over his crib that reads: a) "no blood sampling in lower extremities." b) "no intramuscular injections." c) "do not palpate abdomen." d) "no milk or milk products allowed."

c: Because the kidney has such a rich blood supply, a Wilms' tumor metastasizes rapidly. It is suspected that excess handling causes even more rapid metastasis

The nurse is admitting to an examination room a child with the diagnosis of "probable acute lymphoblastic leukemia." What will confirm this diagnosis? a) History of leukemia in twin b) Lethargy, bruising, and pallor c) Bone marrow aspiration d) Complete white blood count

c: Bone marrow aspiration and biopsy are diagnostic. An abnormal white blood count and symptoms of lethargy, bruising, and pallor only create suspicion of leukemia; a twin may or may not be affected

The nurse is admitting to an examination room a child with the diagnosis of "probable acute lymphoblastic leukemia." What will confirm this diagnosis? a) Lethargy, bruising, and pallor b) History of leukemia in twin c) Bone marrow aspiration d) Complete white blood count

c: Bone marrow aspiration and biopsy are diagnostic. An abnormal white blood count and symptoms of lethargy, bruising, and pallor only create suspicion of leukemia; a twin may or may not be affected

A 4-year-old has developed acute lymphocytic leukemia (ALL). Nursing care for the child with ALL involves taking axillary, rather than rectal, temperatures because the child: a) has a low white blood cell count. b) is anemic. c) has a low platelet count. d) is prone to diarrhea.

c: Children with leukemia develop lesions of the gastrointestinal tract. If touched by a thermometer, these bleed easily; blood coagulation is poor because of a decreased platelet count

Which intervention is best to use with the 6-year-old who has developed stomatitis as a side effect of chemotherapy? a) Use lidocaine rinses b) Limit foods to cool, clear liquids c) Practice frequent, gentle oral hygiene d) Have the child freely choose desired foods and beverages

c: Frequent, gentle oral hygiene will keep the vulnerable oral mucosa clean and will prevent secondary infection. Offering only cool, clear liquids will limit nutrition. "Child freely choosing foods and beverages" gives some control to the 6-year-old but is likely to result in ingestion of foods that are irritating to the mouth, lips, and throat. Lidocaine used as a rinse can create risks for children younger than 8 years because often some is swallowed, and this inhibits the gag reflex.

Why do nurses teach childhood cancer survivors to inform adult health care providers of their prior disease and treatments? a) To obtain health insurance b) To participate in cancer research c) To monitor for late effects d) To access community support groups

c: Numerous children survive childhood cancer. Risks for late effects of earlier disease and treatment require monitoring, prevention, and/or treatment for life. Health insurance, cancer research, and support groups are all important but do not represent the reason for informing an adult health care provider of childhood cancer

The pediatric nurse examines the radiographs of a client that show that there are lesions on the bone. This finding is indicative of: a) Hodgkin disease. b) neuroblastoma. c) Ewing sarcoma. d) non-Hodgkin lymphoma

c: Radiographs that show lesions on the bone may indicate tumors (e.g., Ewing sarcoma, osteosarcoma) or metastasis of tumors and warrant further investigation by bone scan, CT, or MRI. Positron emission tomography is the most effective test to diagnose Hodgkin disease, non-Hodgkin lymphoma, a neuroblastoma, bone tumors, lung and colon cancers, and brain tumors.

The nurse is caring for a 5-year-old boy who will soon die of cancer and is experiencing dyspnea and increasing levels of pain. What would be the priority for pain management with this child? a) Preventing addiction to the opioid medications b) Monitoring the child's vital signs frequently c) Preventing and alleviating pain d) Following the physician's rigid guidelines regarding dosages

c: Recommendations for pain management in this setting place no limits on the dosage of analgesics but rather encourage aggressive dosing and even rapid escalation of dosages to achieve and maintain pain control. The recommendations also state that prevention and alleviation of pain is the nurse's primary goal; that children, parents, and clinicians are equal partners in pain management; and that the nurse's role includes performing and evaluating interventions. Addiction is not an issue with a dying child who is in pain. Vital signs are monitored frequently regardless of the child's pain level. Additionally, the focus of the question is on pain management of the dying child

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? a) Blood b) Brain c) Bladder d) Kidney

c: The most common sites for childhood cancer include the blood, lymph, brain, bone, kidney, and muscle. Bladder is a common site for adult 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? a) Ask whether any family members or other close associates are ill. b) Instruct the parent to immediately obtain and give the antibiotic that the oncologist will order. c) Have the parent bring the child to the pediatric oncology clinic as soon as possible. d) Tell the parent to administer acetaminophen every 4 hours until the fever dissipates.

c: 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

Which diagnosis would be most appropriate for an infant with a large retinoblastoma after surgery? a) Anticipatory grieving related to change in body image b) Fear related to loss of normal vision c) Disturbed sensory perception related to enucleation d) Pain related to retinal removal

c: The primary therapy for a large retinoblastoma is removal (enucleation) of the affected eye.

The parents of a child diagnosed with cerebral astrocytoma ask the nurse about their child's prognosis. Which would be an accurate response? a) "There is a poor overall prognosis with a survival rate less than 10% and a median survival time of 2 years." b) "The survival rate is greater than 95% with radiation and complete surgical resection." c) "The prognosis is favorable with complete surgical resection, with minimal neurologic deficits postoperatively." d) "Survival is variable from several months to 10 years or longer. Children with complete resection have the best prognosis."

c: The prognosis is favorable with complete surgical resection, and clients have minimal neurologic deficits postoperatively. Slow course with insidious onset. Responsive to chemotherapy, often resectable. Causes slowly increasing intracranial pressure. Low-grade tumor may be removed completely. High-grade tumors have poor prognosis

A child with cancer is receiving vincristine. It is most important to observe this child for which of the following side effects? a) Diarrhea b) Flatulence c) Rectal bleeding d) Constipation

d: A common side effect of vincristine therapy is constipation

The nurse is assessing an 11-year-old girl diagnosed with acute myelogenous leukemia (AML) who came to the emergency department. What would alert the nurse to the need for immediate intervention? a) Child reports a headache and vision problems. b) Observation discloses weight loss and muscle wasting. c) Palpation reveals lymphadenopathy in the axillae. d) CBC indicates hyperleukocytosis.

d: About 25% of children with acute myelogenous leukemia present with blood counts greater than 100,000. This is called hyperleukocytosis, and it is a medical emergency requiring leukapheresis to decrease hyperviscosity by quickly decreasing the number of circulating blasts. Lymphadenopathy, headache, visual disturbance, weight loss, and muscle wasting are signs and symptoms common to both types of leukemia. Lymphadenopathy is a common manifestation associated with AML and does not require immediate intervention. Headache and vision problems are common manifestations associated with AML. They do not require immediate intervention. Weight loss and muscle wasting are common manifestations associated with AML. They do not require immediate intervention

A child with ALL is beginning treatment with methotrexate in an attempt to eradicate the leukemic cells. The stage of therapy represents the: a) Delayed intensive-therapy stage b) Consolidation stage c) Sanctuary stage d) Induction stage

d: An induction stage is the first attempt at eradicating the leukemic cells to induce or achieve a complete remission

A group of students are reviewing the different classes of drugs used for cancer chemotherapy. The students demonstrate understanding of these agents when they identify what as cell cycle-specific agents? a) Nitrosoureas b) Alkylating agents c) Nitrogen mustards d) Antimetabolites

d: Antimetabolites are primarily cell cycle-specific agents. Alkylating agents, nitrosoureas, and nitrogen mustards are cell cycle-nonspecific agents.

The nurse is caring for a 2-year-old girl who is receiving chemotherapy using antitumor antibiotics. Which intervention would the nurse question? a) Maintaining meticulous hand-washing procedures b) Administering antiemetics prior to chemotherapy c) Assessing for tachypnea and adventitious breath sounds d) Assessing the mouth for redness, lesions, or ulcers

d: Antitumor antibiotics do not cause mucositis, so it would not be necessary to assess the mouth for redness, lesions, or ulcers. Antitumor antibiotics cause nausea and vomiting, so administering antiemetics prior to chemotherapy would be appropriate. Antitumor antibiotics do cause myelosuppression, so meticulous hand washing would be appropriate. Antitumor antibiotics do cause myelosuppression, placing the child at risk for infection; therefore, assessing for tachypnea and adventitious breath sounds would be appropriate

A 6-month-old girl is seen with retinoblastoma. When taking a health history from her father, which symptom would you expect him to report he has noticed? a) His daughter's eye appears to be protruding. b) His daughter tugs and pulls at one ear. c) The infant always keeps her eyes tightly closed. d) He has noticed one pupil appears white.

d: As the tumor grows against the retina of the eye, the red reflex is no longer visible; the pupil appears white.

A nurse is caring for a 12-year-old girl who is recovering from surgery for removal of a brain tumor. Which intervention should the nurse implement to avoid increasing intracranial pressure? a) Apply saline eye drops, as prescribed b) Place a sterile towel under wet dressings c) Sponge the client's face d) Regulate the rate of IV fluid infusions carefully

d: Be certain to regulate the rate of IV fluid infusions carefully because an increase in the infusion rate has the potential to increase intracranial pressure. The other answers refer to other interventions, unrelated to intracranial pressure

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? a) Keeping a written copy of the treatment plan b) Using acetaminophen if the child needs an analgesic c) Writing down phone numbers and appointments d) Calling the doctor if the child gets a sore throat

d: Calling the doctor if the child gets a sore throat is the priority. Because of the child's impaired immune system, any sign of potential infection, such as sore throat, must be evaluated by a physician. Using acetaminophen if the child needs an analgesic, writing down phone numbers and appointments, and keeping a written copy of the treatment plan are important teaching points but secondary to guarding against infecti

A child is to receive an oral corticosteroid as part of the treatment regimen for leukemia. After teaching the child and family about this drug, the nurse determines the need for additional teaching when they state: a) "He might develop a rounded face from this drug." b) "We will need to gradually decrease the dosage." c) "We should check our son's urine for glucose." d) "We should administer the drug on an empty stomach."

d: Corticosteroids are commonly administered with food to decrease the risk for gastrointestinal upset. Corticosteroids can disrupt glucose balance, so urine should be checked for glucose. A moon face is an adverse effect of corticosteroids. Corticosteroids need to be tapered gradually to reduce the risk of adrenal insufficiency

The nurse is assessing a 14-year-old girl with a tumor. Which finding indicates Ewing sarcoma? a) Child reports dull bone pain just below her knee. b) Child reports persistent pain from minor ankle injury. c) Palpation discloses asymptomatic mass on the upper back. d) Palpation reveals swelling and redness on the right ribs.

d: Ewing sarcoma may result in swelling and erythema at the tumor site. Common sites are chest wall, pelvis, vertebrae, and long bone diaphyses. Dull bone pain in the proximal tibia is indicative of osteosarcoma. Persistent pain after an ankle injury is not indicative of Ewing sarcoma. An asymptomatic mass on the upper back suggests rhabdomyosarcoma

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? a) Have the child wait to void until the bladder becomes full b) Promote drinking of cranberry juice, making it an attractive oral fluid option c) Administer chemotherapy during sleep periods, including naps and overnight d) Keep intravenous (IV) fluids running to maintain excellent hydration and frequent voids

d: IV fluids are given before, during, and after radiation and chemotherapy drugs; bladder irritation results from the need to dilute and remove them from the body. This reduces the need for the child to drink large quantities. Administering the drug during sleep and having the child retain urine would cause irritating chemicals to be kept in contact with the bladder mucosa. No benefit is associated with providing cranberry juice.

A school-aged child with cancer is receiving chemotherapy. Which nursing action would best promote the oral comfort of a child receiving chemotherapy? a) Asking the child to rinse the mouth with salt water b) Encouraging the use of acidic fruit juices to decrease mouth organisms c) Vigorously brushing the teeth and gums to remove secretions d) Keeping the child's lips moist with Vaseline to prohibit cracking

d: If a child has oral lesions from chemotherapy, acidic fruit juice or salt water would sting; vigorous tooth brushing would injure tissue further

The nurse is caring for a 6-year-old girl with leukemia who is having an oncological emergency. Which of the following signs and symptoms would indicate hyperleukocytosis? a) Bradycardia and distinct S1 and S2 sounds b) Respiratory distress and poor perfusion c) Wheezing and diminished breath sounds d) Tachycardia and respiratory distress

d: Increased heart rate, murmur, and respiratory distress are symptoms of hyperleukocytosis (high white blood cell count) which is associated with leukemia. Increased heart rate and blood pressure are indicative of tumor lysis syndrome, which may occur with acute lymphoblastic leukemia, lymphoma, and neuroblastoma. Wheezing and diminished breath sounds are signs of superior vena cava syndrome related to non-Hodgkin's lymphoma or neuroblastoma. Respiratory distress and poor perfusion are symptoms of massive hepatomegaly which is caused by a neuroblastoma filling a large portion of the abdominal cavity.

A child with ALL is given leucovorin, a folinic acid, after high-dose methotrexate therapy. It is important to administer this drug because leucovorin: a) is an experimental drug to ensure resistance to infection during methotrexate therapy. b) helps methotrexate enter leukemia cells the same as insulin helps glucose enter cells. c) will encourage bone marrow to build new cells after methotrexate therapy. d) prevents methotrexate that is not incorporated into leukemia cells from entering normal cells.

d: Leucovorin "rescue" prevents methotrexate from entering normal cells

What is the priority action the nurse should take when caring for a child newly diagnosed with Wilms tumor (nephroblastoma)? a) Assess for constipation. b) Obtain a catheterized urine specimen. c) Control acute pain. d) Protect the abdomen from manipulation

d: Manipulation can release malignant cells into the abdominal cavity. Constipation may be a problem following surgical intervention. Pain is uncommon; obtaining a urine specimen is not a priority.

A child with ALL is receiving methotrexate for therapy. Which nursing diagnosis would best apply to him during therapy? a) Excess fluid volume related to effect of methotrexate on aldosterone secretion b) Risk for impaired mobility related to depressant effects of methotrexate c) Risk for self-directed violence related to effect of methotrexate on central nervous system d) Risk for impaired skin integrity related to oral ulcerations associated with chemothera

d: Many chemotherapy agents cause oral ulcerations that interfere with nutrition because of pain and leave a portal of infection.

What is the best response by the nurse to the parents of a child with leukemia who express guilt because they did not take immediate action when their child seemed to develop one respiratory infection after another? a) "Don't feel bad. Children get lots of colds." b) "You need to focus on the present treatment now and not worry about the past." c) "Young children develop minor illness easily and often. Stop being hard on yourselves." d) "Keep in mind that the signs of leukemia are often subtle and difficult to recognize."

d: Pointing out that the signs and symptoms of leukemia are often difficult to recognize indicates to the parents that they were not neglectful, while also providing information about the disease. The other responses minimize the parents' feelings or tell them how they should feel and are not therapeut

The nurse is caring for a 17-year-old girl in the terminal phase of osteosarcoma. Which action demonstrates integration of the recommendations of the American Academy of Pediatrics (AAP) Committee on Bioethics? a) Allowing the child to listen during discussions of the care plan b) Explaining the prognosis using accepted clinical terminology c) Encouraging the child to support the wishes of her parents d) Telling the child exactly what to expect of further treatments

d: The committee recommends telling the child exactly what to expect of further treatments and procedures, explaining the prognosis in a developmentally appropriate way to ensure the child's understanding, and endeavoring to gain the child's candid opinion of the proposed care plan. It also recommends that decision making for older children and adolescents should include the assent of the child or adolescent

The nurse is caring for a 6-year-old boy with an abdominal neuroblastoma prior to having a magnetic resonance imaging (MRI) scan without contrast done. Which intervention would the nurse expect to perform? a) Applying EMLA to the injection site prior to inserting the IV b) Encouraging fluid intake to increase radionuclide uptake c) Advising the physician that the child is allergic to shellfish d) Administering a sedative as ordered to keep the child still

d: The nurse would expect to administer a sedative as ordered to keep the child still because the machine makes a loud thumping noise that could frighten the child. The child must lie without moving while the MRI is being done. Encouraging fluid intake to increase radionuclide uptake is necessary for a bone scan. Advising the physician that the child is allergic to shellfish is an intervention for a computed tomograph (CT) scan with contrast. If the child did not have an IV prior to the MRI and contrast was going to be used, then an IV would need to be inserted for the contrast after the noncontrast MRI was finished. Applying EMLA to an injection site prior to inserting an IV would be appropriate for both the CT and bone scans

The nurse is caring for 9-year-old boy undergoing chemotherapy whose complete blood count (CBC) with differential reports 7% banded and 13% segmented neutrophils with a white blood cell count of 2,540. He has an oral temperature of 38.6°C. Which intervention would be the priority? a) Assessing for signs of infection every 8 hours b) Restricting visitors with symptoms of infection c) Monitoring his vital signs every 4 hours d) Administering prescribed broad-spectrum IV antibiotics

d: The priority intervention for this child is administering prescribed broad-spectrum IV antibiotics. His absolute neutrophil count (ANC; calculated by adding the bands and segs [21%] and then multiplying this [0.20] by the white blood cell count [2540] to yield an ANC of 508) indicates he has neutropenia and his temperature indicates he may have an infection. Monitoring vital signs, restricting visitors with symptoms of infection, and assessing for signs of infection are valid interventions related to neutropenia but are of lesser importance at this point

The nurse preparing clients for diagnostic testing for cancer knows that the following test is used to differentiate a neuroblastoma from other tumors: a) Urinalysis b) Serum chemistries c) CBC with differential d) Urine catecholamines VMA, HVA

d: Urine catecholamine metabolites homovanillic acid (HVA) and vanillylmandelic acid (VMA) differentiate neuroblastomas from other tumors. Urinalysis provides general information about renal function. Serum chemistries help to evaluate the body's response to the cancer process. CBC with differential determines abnormal loss or destruction of cells that may indicate cancer or bone marrow suppression