Onco- Peds test 4
A young child has been diagnosed with Wilms tumor. The parents ask how this could have happened to their child. What is the nurse's best response?
Answer: "This is usually related to a gene mutation." Rationale: A number of gene mutations have been identified as associated with Wilms tumor. It does not seem to be related to viral exposure or environmental factors.
The nurse is admitting an 8-year-old client diagnosed with a metastatic brain tumor. When the client's 5-year-old sibling becomes loud and distracting, the nurse identifies this behavior as:
Answer: sibling jealousy. Rationale: The sibling is displaying jealousy and a desire for the parent's attention. Though the sibling understands there is an illness, the child still has a need for parental attention and feels angry about disruptions in the family. Toddlers experience temper tantrums and egocentric behavior, not preschoolers. Five-year-olds are able to follow directions and behave in a hospital setting.
Place the tumor stages in order from I to IV. Use all options.
Answer: 1)Tumor has not extended into surrounding tissue and may be completely removed surgically 2)Tumor has spread locally but the chance for complete surgical removal is good 3)Cancer cells have spread to local lymph nodes 4)Tumors have spread systemically Rationale: Tumor staging is a procedure by which a malignant tumor's extent and progress are documented. 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 and may be completely removed surgically; Stage III typically means cancer cells have spread to local lymph nodes; stage IV designates tumors that have spread systemically (metastasis).
Parents ask why their child just diagnosed with leukemia needs a "spinal tap." Which is the best response by the nurse?
Answer: "Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system." Rationale: The cerebrospinal fluid is checked so the clinician can determine whether leukemic cells have invaded the central nervous system. It is common for a chemotherapy medication, usually methotrexate, to be administered immediately following lumbar puncture as treatment for potential infiltration.
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.
Answer: The child has no hair on his head., The child's mother states, "It seems like he catches every bug that comes along.", The child's mother states that she often has to repeat herself because he can't hear very well., The child reports feeling nauseated Rationale: Common adverse effects of chemotherapeutic drugs are: immunosuppression, alopecia, hearing changes, and nausea. Another common adverse effect is microdontia, not enlarged teeth.
A child is receiving chemotherapy. The chemotherapy is scheduled to begin at 10 a.m. To prevent nausea and vomiting, the child is prescribed ondansetron. At what time would it be best to administer the medication?
Answer: 9:30 a.m. Rationale: To prevent nausea and vomiting from chemotherapy, ondansetron should be given 30 minutes before beginning chemotherapy. For this child, the correct time would be 9:30 a.m.
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?
Answer: Educating the child and family about the testing procedures Rationale: The priority would be educating the child and family about the testing procedures so they know what to expect and understand why the tests are being performed. Applying EMLA to the lumbar puncture site will be done prior to the procedure. The family will be educated about chemotherapy and its side effects prior to the therapy beginning, and promethazine or other antiemetics will be administered once chemotherapy has begun.
A mother contacts the oncology nurse concerned about the redness and tenderness of her child's skin following radiation treatments. What is the nurse's best response?
Answer: Use mild soap and nonscented moisturizer. Rationale: Skin reactions, such as erythema and tenderness, are typical local effects. Maintaining good skin hygiene and use of mild soaps or moisturizers (nonfragrant) may help preserve skin integrity. Keeping skin clean and dry is helpful, but the skin needs a mild moisturizer to preserve skin integrity. Covering with an occlusive dressing is not helpful, as the skin needs hydration. Telling the mother there is nothing that can be done is inaccurate.
The nurse is preparing a presentation for a parent group about childhood cancers, focusing on brain tumors in children. What would the nurse describe as the most common type of brain tumor?
Answer: medulloblastoma Rationale: Of all the types of brain tumors listed, a medulloblastoma is the most common type. It is invasive, is highly malignant, and grows rapidly.
A nurse is assessing a child with cancer and suspects that the child has developed sepsis based on what findings? Select all that apply.
Answer: Absolute neutrophil count (ANC) less than 500, Increased blood urea nitrogen (BUN), Hyperkalemia Rationale: Findings associated with sepsis include ANC less than 500, increased BUN, increased potassium, decreased platelets, and metabolic acidosis.
1. The nurse caring for a cancer patient recognizes the signs and symptoms of syndrome of inappropriate antidiuretic hormone (SIADH) in a patient. Which of the following are recommended interventions for this emergency condition? Select all that apply.
Answer: · Restrict fluids to below maintenance levels. · Monitor intake and output. · Monitor specific gravity of each voiding. · Monitor serum sodium levels. Rationale: The appropriate interventions for SIADH are to restrict fluids to below maintenance levels; administer diuretics; and monitor intake and output, specific gravity of each voiding, serum sodium levels, and seizure activity.
A child being treated for leukemia is diagnosed with neutropenia. What nursing instructions directly prevent client infections? Select all that apply.
Answer: Avoid large crowds. Inspect the skin daily for scratches or scrapes. Remove house plants, flowers, and goldfish from the home environment. Stay away from people who have obvious colds, rashes, or other infections. Rationale: Strategies to prevent infections in a child with neutropenia include avoiding large crowds; inspecting the skin daily for scratches or scrapes; removing house plants, flowers, and goldfish from the home environment; and staying away from people who have obvious colds, rashes, or other infections. The child's intake of fresh fruits and vegetables should be limited because this could be a source for bacteria.
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? Select all that apply.
Answer: Loss of appetite Nausea Vomiting Skin redness Rationale: Immediate effects of radiation therapy include anorexia, nausea, vomiting, extreme fatigue, and skin reactions such as erythema and tenderness. Shortening of the spine and sleepiness are considered long-term side effects.
The nurse is providing care to a child being treated for cancer. The nurse determines that the child is developing disseminated intravascular coagulation based on assessment of which of the following? Select all that apply.
Answer: Purpuric rash, Platelet count 100,000/mm3, Uncontrolled bleeding Rationale: Symptoms of DIC include: uncontrolled bleeding, petechiae, eccymosis, purpuric rash, prolonged prothrombin time and partial thromboplastin time, platelet count, 100,000/mm3, increased D-dimer assay, decreased antithrombin III levels, below-normal fibrogin levels, and increased fibrin-degration products.
What are important considerations when the nurse is planning care for the family of a child with cancer? Select all that apply.
Answer: prognosis of cancer family's coping strategies prevention and alleviation of pain monitoring for side effects of treatment stage of grief of child, parents, and siblings Rationale: The nurse will need to consider the prognosis, the family's coping, prevention and alleviation of pain, monitoring for side effects of chemotherapy and radiation, and the stage of grief of the child, parents, and siblings. The child's gender is irrelevant to planning nursing care.
The health care provider has just informed the parents of a 3-year-old that their child has leukemia. The mother begins crying and tells the nurse she does not want her baby to die. What is the nurse's best response?
Answer: "I know this is scary, but leukemia has a 95% cure rate in children these days." Rationale: Because of the tremendous advances in cancer research and treatment over the past 20 years, the prognosis for children and the chances for a cure improve daily. Up to 95% of children with the most common form of leukemia, for example, can expect to be cured. Praising the health care provider is not therapeutic because it denies the mother's fears. Acknowledging her fears is therapeutic, but informing her of the high cure rate is more helpful. It is doubtful that any parent feels "lucky" when hearing a diagnosis of cancer, and hearing this will not make the treatment any easier.
Parents of a 10-year-old have just been informed that their child has stage III cancer. They ask the nurse what this means. What is the nurse's best response?
Answer: "The cancer cells have spread to the lymph nodes." Rationale: Stage III typically means cancer cells have spread to local lymph nodes. Stage IV designates tumors that have spread systemically to other organs. Stage I refers to a tumor that has not extended into the surrounding tissue. Stage II means there is some local spread, but the chance for complete surgical removal is good.
The parents of a child diagnosed with cerebral astrocytoma ask the nurse about their child's prognosis. Which response by the nurse would be most appropriate?
Answer: "The prognosis is favorable with complete surgical resection and the child usually experiences minimal neurologic deficits post-operatively." Rationale: Cerebral astrocytomas account for approximately 25% of all types of astrocytomas. The prognosis is favorable with complete surgical resection, and patients have minimal neurologic deficits post-operatively.
The nurse caring for a pediatric patient with diffuse large B-cell lymphoma knows that two-thirds of the cases present with advanced disease, most commonly in which location? :
Answer: Abdomen Rationale: Two-thirds of the cases of large B-cell lymphoma present with advanced disease, most commonly in the abdomen. Lymph node involvement, bone marrow, mediastinal and CNS disease are not common.
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?
Answer: Administering a sedative as ordered to keep the child still. Rationale: 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.
A nurse is caring for a teen who is in the end stage of cancer. Which of the following nursing interventions provides self-esteem and self-worth to the teen?
Answer: Allowing the teen to completely participate in decisions Rationale: The adolescent stage of development thrives on feelings of self-worth and self-control. Allowing the teen to be involved in the care and decisions will increase self-esteem.
The nurse works with a child with cancer who will be undergoing radiation therapy. What is the first step the nurse would take to ensure the child has given assent for this procedure?
Answer: Assess the child's understanding of the treatment. Rationale: For children experiencing cancer many treatment options are difficult to accept and endure. These decisions for treatment have to be consented to by parents, but for the older child and the adolescent all treatment plans should include assent from the child. Several steps are involved in this process, but the nurse should first assess what the child knows and feels about the treatment. Educating the child about the treatment should be done after the nurse determines the child's developmental level and helps the child learn on the child's developmental level. The child should be told honestly what to expect during the treatment. The nurse should determine if there is any inappropriate pressure on the child to assent. Many times the desires for treatment cause conflict between the parents and the child. Child Life specialists can be very useful in helping the child deal with treatment plans and work through feelings.
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.
Answer: Assessment discloses hyphema in one eye., Parents report that the child has headaches., History reveals strabismus., Observation confirms cat's eye reflex in pupil. Rationale: 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.
A nurse working in a cancer center is preparing to administer medication to a 5-year-old child. Which method of dosage calculation provides the most accurate dose of medication?
Answer: Body surface area Rationale: Body surface area is the external surface of the body expressed in square meters. The ratio of body surface area to weight is inversely proportional to length. Drug calculation using body surface area is more accurate than using the weight of the child alone. The methods of using the child's age in months and years are no longer recommended to calculate drug dosages for pediatric patients.
The nurse examining a child who was diagnosed with acute lymphoblastic leukemia (ALL) 6 months ago. The child exhibits pallor, ecchymoses, and petechiae. The nurse interprets these findings as indicating that the cancer has invaded which part of the body?
Answer: Bone marrow Rationale: A child with cancer often appears pale and thin, with symptoms of lethargy and generalized malaise. The presence of pallor, ecchymoses, and petechiae may indicate that the cancer has invaded the bone marrow and is interrupting the normal production of red blood cells and platelets, as in leukemia.
Which mechanism is central to cancers in children?
Answer: Cellular growth Rationale: Certain pediatric malignancies clearly occur at times of peak physical growth and cellular maturation. This coincidence suggests that cellular growth and development are central to the mechanism of cancer in children. In contrast, environmental exposures are a primary component of carcinogenesis in adults. Genetics and race are not commonly identified as related to pediatric cancers.
The nurse is caring for a 9-year-old boy who is having chemotherapy. The nurse is developing a teaching plan for the child and family about nutrition. What instruction would the nurse be least likely to include?
Answer: Concentrating on consuming primarily high-calorie shakes and puddings. Rationale: Providing high-calorie shakes and puddings with diet restrictions can help with weight gain, if that is a problem. However, concentrating on high-calorie shakes and puddings is not a good strategy. It is best to provide a balanced diet emphasizing grains, fruits, and vegetables. If pain is being treated with opioid analgesics, featuring high-fiber foods is important to help relieve constipation. Avoiding milk products is a good idea if diarrhea is a problem because lactose can make diarrhea worse.
A child with cancer is receiving vincristine. It is most important to observe this child for which of the following side effects?
Answer: Constipation Rationale: A common side effect of vincristine therapy is constipation.
1. Which diagnosis would be most appropriate for an infant with a large retinoblastoma after surgery?
Answer: Disturbed sensory perception related to enucleation Rationale: Retinoblastoma is a congenital highly malignant tumor. When there is early detection the goal is to treat the tumor and preserve as much vision as possible. If there is advanced disease, enucleation is necessary. It may be difficult for an infant or young child to learn to see the world with only one eye and adapt to this sensation. Pain may be present but it is not related to retinal removal. The entire eye structure is removed. If the eye needs to be removed the child has not experienced normal vision for some time previous to surgery so there would not be fear relating to the loss of normal vision. Anticipatory grieving would occur more from the parents than the infant.
The nurse cares for adolescents with cancer. Which recommended psychosocial interventions will the nurse use to help the adolescents cope with their disease? Select all that apply.
Answer: Encourage the adolescents to make plans for the future., Encourage adolescents to engage in their usual activities., Control the amount of information given out about the adolescents' conditions. Rationale: Adolescents need as normal as possible of a life to experience things other children their age do. 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. Children should attend school as long as their white blood cells are not dangerously low. They can participate in activities if their platelets are adequate to prevent any bleeding from accidents while playing sports. The nurse should be a friend as well as an advisor to the adolescents.
The nurse is teaching parents about help improving their child's nutritional status while on chemotherapy. What information would be included in the teaching? Select all that apply.
Answer: Encourage the child to pick foods that are appetizing., Maintain pleasant family meal times even if child is not hungry., Provide nutritious snacks such as a milkshake., Suggest eating prior to chemotherapy. Answer: Urge parents to be careful that mealtime remains a pleasant time, even if the child is not eating well. Encourage them to allow the child to make choices whenever possible. Offer small portions because a small meal fully finished is usually more satisfying than a large meal half finished. Being certain snack foods are nutritious (perhaps a malted milkshake rather than a cola beverage) is another way to increase nutrient intake. Suggest eating larger meals early in the day before chemotherapy begins, when the child is less likely to be nauseated. However, do not recommend honey as a sweetener. Botulism organisms can grow in honey, placing the immunosuppressed child at risk for infection. Also, it is better to offer smaller portions at mealtime rather than larger portions, as the child is not likely to be able to eat as much.
A child has undergone a hematopoietic stem cell transplant. When assessing the child, the nurse notes the development of a maculopapular rash on the child's palms and bottoms of the feet. Which condition would the nurse suspect?
Answer: Graft-versus-host disease Rationale: Graft-versus-host disease involves the development of a maculopapular rash on the palmar and plantar surfaces of the hand and feet evolving into erythematous rash over most of body (ranging from slight redness of the skin to complete skin desquamation. Disseminated intravascular coagulation would involve signs of bleeding, including bruising, petechiae and ecchymoses. Graft failure would be manifested by fever, infection and a decrease in blood counts. Veno-occlusive disease would be manifested by sudden, unexpected weight gain, thrombocytopenia, jaundice, hepatomegaly, right upper quadrant pain, ascites and encephalopathy.
A nurse is caring for a terminally ill 7-year-old who is hospitalized and is wishing to go home? What type of referral can this nurse make so that the child can receive care at home?
Answer: Hospice care Rationale: Many children in terminal stages of disease are also cared for at home with hospice care.
A child with leukemia is receiving methotrexate for therapy. Which nursing diagnosis should the nurse use to best guide this child's care at this time?
Answer: Impaired oral mucous membrane related to effects of chemotherapy Rationale: Mucositis or ulcers of the gum line and mucous membranes of the mouth is a frequent effect of antimetabolic drugs. This is the diagnosis that would have the highest priority for the client's care at this time. Methotrexate does not impair mobility, impact aldosterone secretion, or cause adverse effects to the central nervous system.
A child is receiving methotrexate as part of his chemotherapy protocol. The nurse would anticipate administering which agent to counteract the toxic effects of methotrexate?
Answer: Leucovorin Rationale: Leucovorin is given as an antidote to methotrexate to reduce its toxic effects. Mesna is given when cyclophosphamide and ifosfamide are used to prevent hemorrhagic cystitis. Cyclosporine is an immunosuppressant used to treat graft-versus-host disease after hematopoietic stem cell transplant. Nystatin is used to treat mucositis or systemic fungal infection.
A 12-year-old child is suspected of having Hodgkin lymphoma. When preparing the child and family for diagnostic testing, which test would the nurse describe as being used to confirm the diagnosis?
Answer: Lymph node biopsy Rationale: Hodgkin lymphoma is confirmed by biopsy of the lymph nodes. Further studies such as bone marrow analysis, liver function tests, chest and abdominal computed tomography scans, lymphangiography, and abdominal biopsy are done to classify the clinical stage of the disorder.
A child is receiving carboplatin as part of a chemotherapy protocol. What would be most important for the nurse to include in the child's plan of care?
Answer: Maintaining adequate hydration Rationale: When fluorouracil is administered, the nurse must ensure adequate hydration. Monitoring for visual changes is appropriate when giving fludarabine. Eye drops are necessary to prevent conjunctivitis when high doses of cytarabine are administered. Oral mercaptopurine should not be given with meals or food.
1. 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?
Answer: Monitoring for allergic reactions or anaphylaxis. Rationale: 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 also require hydration maintenance. 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.
A child with stage III rhabdomyosarcoma develops tumor lysis syndrome. Which actions would be appropriate to include when providing care to this child? Select all that apply.
Answer: Monitoring intake and output; providing dialysis if renal failure occurs, Managing electrolytes using oral and IV solutions specific to electrolyte needs, Monitoring serum chemistry levels, Administering allopurinol or rasburicase to reduce uric acid production Rationale: With tumor lysis syndrome, the nurse should provide IV hydration to flush cell by-products through the kidneys; administer diuretics; administer allopurinol or rasburicase to reduce uric acid production; monitor serum chemistry levels; manage hyperkalemia, hyperuricemia, hyperphosphatemia, and hypocalcemia using oral and IV solutions specific to electrolyte needs; monitor intake and output; and provide dialysis if renal failure occurs.
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?
Answer: Most childhood cancers affect the tissues rather than organs. Rationale: Childhood cancers usually affect the tissues, not the organs, as in adults. Metastasis often is present when the childhood cancer is diagnosed. Childhood cancers, unlike adult cancers, are very responsive to treatment. Unfortunately, little is known about cancer prevention in children.
Parents of a child with a malignant brain tumor are having difficulty coping and are having doubts about the reality of the diagnosis. How should the nurse address their immediate needs? Select all that apply.
Answer: Offer factual information about the disease process and prognosis., Provide emotional support and encourage verbalization of feelings., Provide copies of lab work and pathology biopsy reports. Rationale: How the parents handle this initial disbelief has a great deal to do with their relationship with health care personnel. If they have a trusting relationship with health care providers from past experiences, they are more likely to seek information and support from the providers. The nurse should be certain they have received factual explanations and evidence of the diagnosis such as through a copy of the blood or the pathologist's biopsy report. Urge them to talk about how they feel and ask questions. Facts regarding the illness, the challenges it may present and also the terminal nature of it will assist parents to accept the diagnosis and identify strategies to adapt. If they lack trust in the providers, they may not believe the diagnosis and feel the need to obtain a second opinion. Although this often involves considerable expense, for many parents, it is a necessary step in moving past this first reaction. Parents who feel a need for a third, fourth, or fifth opinion may be having an unusually difficult time resolving a "surely not me" response. It is beneficial to support a second opinion to help accept the disease, but multiple opinions will not change the results. Parents at this point are not ready for a support group. Encouraging hope or alternative treatments only prolongs the denial.
A child underwent surgery for removal of an astrocytoma. What would be most appropriate to include in the plan of care?
Answer: Positioning the child on the unaffected side Rationale: Postoperatively, the nurse will position the child on the unaffected side, with the head of the bed flat or at the level prescribed by the neurosurgeon. The foot of the bed is not elevated to prevent increasing intracranial pressure and contributing to bleeding. Fluids are administered carefully to avoid excess fluid intake, which would cause or worsen cerebral edema.
Which intervention is best to use with the 6-year-old who has developed stomatitis as a side effect of chemotherapy?
Answer: Practice frequent, gentle oral hygiene Rationale: Frequent, gentle oral hygiene will keep the vulnerable oral mucosa clean and will prevent secondary infection. Offering only cool, clear liquids will limit nutrition. 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.
A child is undergoing a series of diagnostic tests for a suspected malignancy. Which diagnostic test result is only present in Hodgkin disease?
Answer: Reed-Sternberg cells Rationale: With Hodgkin disease, lymphocytes proliferate in the lymph glands, and special Reed-Sternberg cells (large, multinucleated cells that are probably nonfunctioning monocyte-macrophage cells) develop. Although these lymphocytes are capable of DNA synthesis and mitotic division, they are abnormal because they lack both B- and T-lymphocyte surface markers and cannot produce immunoglobulins as do usual B-lymphocytes. There will be elevated lymphocytes, but this is present in leukemias as well. T-lymphocyte surface markers are lacking in Hodgkin disease. Megakaryocyte cells are normal cells in the bone marrow and produce platelets.
A parent contacts the oncology clinic nurse with concerns about mucositis following chemotherapy. Which are appropriate interventions for the nurse to include? Select all that apply.
Answer: Serve soft foods rather than hard or crunchy foods., Have the child drink as much fluids as possible to remain hydrated., Encourage rinsing the mouth with lukewarm water., Use a soft toothbrush and swish with an antibiotic mouthwash. Rationale: Encourage serving soft foods such as mashed potatoes and pudding rather than hard ones, such as toast or crunchy cereal, to avoid abrasions to tender gum lines. Encourage rinsing the mouth with lukewarm water about 3 times a day for comfort and to encourage healing. Have the child drink as much fluid as possible to remain hydrated, which helps to keep the lips from cracking. Use a soft toothbrush and swish an antibiotic mouthwash if sores are present. Avoid acidic foods such as orange juice, which can sting if sores are present. Keep lips well lubricated with petroleum jelly or a commercial product to prevent lips from cracking.
The nurse is caring for a 6-year-old girl with leukemia who is having an oncological emergency. Which signs and symptoms would indicate hyperleukocytosis?
Answer: Tachycardia and respiratory distress Rationale: 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.
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?
Answer: The child has Beckwith-Wiedemann syndrome.
The nurse is caring for a 4-year-old child with acute lymphocytic leukemia (ALL). Why should the nurse assess this child's temperature using the axillary route instead of a rectal temperature?
Answer: The child has a low platelet count. Rationale: Because platelet production is limited in children with leukemia, children are extremely prone to hemorrhage. Gastrointestinal bleeding can occur. An axillary temperature is not taken because the child has anemia, prone to diarrhea, or has a low white blood cell count.
A nurse is providing teaching to a child receiving chemotherapy and the parents. The nurse determines that the teaching was successful when the parents state that they will contact the primary health care provider if which occurs?
Answer: The child has redness or swelling at the central venous access site. Rationale: The family should contact the health care provider if the child has a temperature of 101.5 degrees F 38.6 degrees C) or higher or a temperature of 100.5 degrees F to 101.4 degrees F (38.1 degrees C to 38.5 degrees C) lasting more than 4 hours; appears seriously ill without a fever; has shaking chills, fever, or both after flushing the vascular access device; is confused, has slurred speech, or is difficult to arouse; is extremely weak or pale; has bruising or bleeding; has repeated excessive vomiting or diarrhea; has decreased urinary output or blood in urine; exhibits redness, swelling, or leakage at the central venous access site; or if the device has cracks, is pulled out, or does not flush.
Which symptom would lead the nurse to suspect that a child is developing a common side effect of vincristine?
Answer: The child says the fingertips feel numb. Rationale: Vincristine has a number of side effects. Myelosuppression occurs,, which can cause decreased blood counts, hemorrhage, and anemia. A common side effect of vincristine is numbness and tingling in the hands and feet. Allopurinol is administered when the child is receiving vincristine, because the dying cancer cells cause increased uric acid. A side effect of the allopurinol is blistering, peeling, and red skin rash. With both of the drugs the child should be properly hydrated to prevent side effects. Toothache and hearing loss are symptoms of side effects of other chemotherapeutic agents, but not vincristine.
The nurse is assessing a 3-year-old boy whose parents brought him to the clinic when they noticed that the right side of his abdomen was swollen. What finding would suggest this child has a neuroblastoma?
Answer: The parents report that their son is vomiting and not eating well. Rationale: Along with the swollen abdomen on one side, the parents reporting that the child is vomiting and anorexic points to the possibility of a neuroblastoma. Observing a maculopapular rash on the child's palms is a sign of graft-versus-host disease. Irritability and lack of weight gain suggest a possible brain tumor as well as malabsorption problems. Auscultation revealing wheezing with diminished lung sounds would suggest other problems, not a neuroblastoma.
A young child has just received a prosthesis following enucleation due to retinoblastoma. Which nursing instruction is appropriate? Select all that apply.
Answer: The prognosis for retinoblastoma is good., Follow up evaluations will be needed for vision changes., All children in the family will need to have eye examinations., Future testing will need to be done to determine if metastasis has occurred. Rationale: Retinoblastoma is a malignant tumor of the retina of the eye. Because the 5-year survival rate for children with retinoblastoma is good (at least 90%), this is an important counseling role (Rowland & Metcalfe, 2013). In about 10% of children, these tumors develop because of an inherited autosomal dominant pattern that causes an alteration of chromosome 13. Parents who have one child with retinoblastoma have about a 4% chance of having a second child with a similar tumor. Children with a family history should have an ophthalmic exam usually under general anesthesia or conscious sedation at least 3 times yearly until they reach 5 years of age. Evaluation of the child after retinoblastoma must include not only whether metastasis can be detected but also whether the child is adjusting to any loss of vision. An eye prosthesis is fitted about 3 weeks after surgery. Prostheses in children do not need to be removed and cleaned daily, and in children this young, leaving the prosthesis in place prevents the child from removing and playing with it (an interesting, colorful, round ball). If the tumor has metastasized, the child may also receive radiation treatment and chemotherapy; therefore, surgery is not a cure.
The health care provider prescribes an alkylating agent as part of a child's chemotherapy regimen. When explaining this classification of drug to the child and parents, which information would the nurse integrate into the explanation?
Answer: They are cell cycle-nonspecific destroying both resting and dividing cells Rationale: 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.
The health care provider prescribed an alkylating agent for a child's chemotherapy. Which best describes an action produced by these types of agents?
Answer: They are cell cycle-nonspecific, destroying both resting and dividing cells. Rationale: 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. Interferons are the classification of drugs that are synthesized by bacterial and fungal agents. Antimetabolites are active in the S phase and act similarly to normal cellular metabolites. They alter the cell's function to destroy the cell's ability to replicate.
A child is diagnosed with osteogenic sarcoma. The nurse is preparing a teaching plan for the child that addresses the treatment options. Which of the following would the nurse most likely include? Select all that apply.
Answer: Tumor removal, Limb salvage, Amputation Rationale: After diagnosis has been confirmed, surgical intervention is a vital treatment for children with osteogenic sarcoma. Tumor removal, limb salvage procedures, and amputation are all viable surgical options. IN addition, chemotherapy is also used for all patients, playing a substantial role in improving survival rates.
1. The nurse is preparing clients for diagnostic testing for cancer. Which test is used to differentiate a neuroblastoma from other tumors?
Answer: Urine catecholamine metabolites, homovanillic acid (HVA), and vanillylmandelic acid (VMA) Rationale: Neuroblastomas produce catecholamines. Urine catecholamine metabolites, homovanillic acid (HVA), and vanillylmandelic acid (VMA) differentiate neuroblastomas from other tumors. This exam is done by collecting a 24-hour urine specimen. 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.
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 (101.5°F). Which intervention would be the priority?
Answer: administering prescribed broad-spectrum IV antibiotics Rationale: 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.
A child is sent to pediatric intensive care following surgery for a brain tumor. Which prescription would the nurse question?
Answer: elevate head of bed 90 degrees Rationale: An anticonvulsant such as phenytoin will be prescribed if the child is experiencing seizures or if surgery is apt to induce seizures. A child will usually receive a stool softener such as docusate sodium to prevent straining with bowel movements. In general, a child is positioned on the side opposite the surgical incision. Keep the bed flat or only slightly elevated, again, as prescribed, because this helps to reduce intracranial pressure from accumulation of fluid in the surgical area. Therefore, the nurse would need to question the prescription to elevate the head of bed 90 degrees.
The nurse is meeting with a parent and child at the pediatric clinic. Which statement made by the parent during the history would alert the nurse that there might be a possible malignancy in the child?
Answer: fever with no response to repeated antibiotics Rationale: Abnormal duration of symptoms that have lingered or increased over an unusually long period (e.g., a fever that has not responded to antibiotics) and has lasted longer than expected for recovery from acute illness could be a sign of a malignancy. Frequent stomach aches could stem from a variety of issues, such as irritable bowel syndrome. Recurrent headaches while reading may relate to visual changes. Swollen cervical lymph nodes with pharyngitis are typically viral or bacterial in nature.
A child with acute lymphocytic leukemia is given leucovorin, a folinic acid, after high-dose methotrexate therapy. It is important to administer this drug because leucovorin:
Answer: prevents methotrexate that is not incorporated into leukemia cells from entering normal cells. Rationale: Leucovorin "rescue" prevents methotrexate from entering normal cells.
A child with cancer is scheduled for a stem cell transplant. The parents ask the nurse why this procedure is being done. What is the nurse's best answer?
Answer: to allow higher doses of chemotherapy Rationale: Transplantation of stem cells from the bone marrow of a well person to a child with cancer has become a frequently used treatment. The procedure allows higher doses of chemotherapy and radiation to be used because, in the event of severe bone marrow depression, the child can have healthy marrow restored. Immune cells in the transplanted marrow may actually help to kill remaining cancer cells in the child's circulation. Stem cells to do not prevent further metastasis or infections while on chemotherapy. Stem cells do not suppress the child's immune system; rather, chemotherapy given prior to stem cell transplant is used to suppress the child's immune response.
