Oncology

A 4-year-old complains of extreme pain when the tragus is touched. Though not diagnostic, this sign is most indicative of which disorder? acute otitis media acute tympanic effusion otitis interna otitis externa

otitis externa

The parent's of a 4-year-old brings the child to the clinic and tells the nurse the child's abdomen is distended. After a complete examination, a diagnosis of Wilms tumor is suspected. Which of the following is most important when doing a physical examination on this child? Avoid palpation of the abdomen Assess urine for presence of blood Monitor vital signs, especially the blood pressure Obtain and accurate weight and height

Avoid palpation of the abdomen Palpating the abdomen of the child in whom a diagnosis of Wilms tumor is suspected should be avoided because manipulation of the abdomen may cause seeding of the tumor.

The nurse is evaluating bloodwork results of a client with cancer who is receiving chemotherapy. The client's platelet count is 60,000/mm3. Which is an appropriate nursing action? Taking the client's temperature rectally Providing commercial mouthwash to the client Providing a razor so the client can shave Avoiding the use of products containing aspirin

Avoiding the use of products containing aspirin A platelet count of 60,000 is low and places the patient at risk for thrombocytopenia. Avoiding the use of products containing aspirin will help to minimize the possibility of further decreasing the platelet level and causing the patient to bleed.

The nurse is completing discharge teaching with the parents and their child who underwent a cardiac catheterization through the left femoral artery 8 hours ago. Which information should the nurse include? Select all that apply. Check pulses on the affected leg hourly. Call HCP if the left foot is cooler than the right Encourage the child to drink fluids as tolerated. Allow only quiet play activities until tomorrow. Call HCP if child experiences a fever.

Call HCP if the left foot is cooler than the right Encourage the child to drink fluids as tolerated. Allow only quiet play activities until tomorrow. Call HCP if child experiences a fever. cool foot is sign of decreased perfusion parents can easily assess encourage fluids to help flush the dye from procedure from the body Activity should be limited for 24 hours after procedure to prevent dislodgement of clot fever is a sign of infection which can occur after an invasive procedure Incorrect- Hourly assessment is unnecessary at 8 hours postcatheterization

The nurse is caring for a pediatric client who is dying. The best way to provide care and comfort to dying clients and their families is to first do which of the following? A workshop on caring for the dying client Use evidence-based practice in daily care regimen. Explore own feelings on mortality and death and dying. Participate in a support group to learn clients' feeling on care.

Explore own feelings on mortality and death and dying.

The mother of a 5 month-old infant with heart failure questions the necessity of weighing her baby every morning. The nurse's response is based on the fact that this daily information is important in determining: Fluid retention Kidney function Nutritional status Medication dosage

Fluid retention - Fluid retention is reflected by an excessive weight gain in a short period of time. Inadequate cardiac output decreases the blood flow to the kidneys, thus leading to increased intracellular fluid and hypervolemia. AWeigh changes from nutritional will change gradually but don't vary greatly on day to day basis Although weight is used to determine medication dosages, the dosage does not need to be recalculated according to daily weights. Also note the focus of the question is in relationship to heart failure, the connection should be made to fluid retention.

A nurse is preparing a school-aged child for a lumbar puncture. The nurse would expect to position the child in which manner? On her side with the head flexed forward and knees flexed to the abdomen Sitting upright with the head flexed forward to the chest Supine with arms and legs pronated and extended Prone with the arms flexed under the chest

On her side with the head flexed forward and knees flexed to the abdomen When a lumbar puncture is performed on a child, the child is placed on his or her side with the head flexed forward and knees flexed to the abdomen. An infant would be positioned sitting upright with the head flexed forward. A supine position with the arms and legs pronated and extended suggests decerebrate posturing. A prone position is not used for a lumbar puncture.

A terminally ill patient in pain asks the nurse to administer enough pain medication to end the suffering forever. What is the best response by the nurse? "I can't do that, I will go to jail." "I am surprised that you would ask me to do something like that." "I will notify the physician that the current dose of medication is not relieving your pain." "I will see if the physician will order enough for that to occur."

"I will notify the physician that the current dose of medication is not relieving your pain."

A client with advanced cancer makes the following comment to the nurse: "Why are you bathing me? I am going to die no matter what." What is the most appropriate response of the nurse? "A bath will make you feel better." "Do you want to skip the bath today?" "Would you like to talk about what you are feeling?" "I can give you some medicine to make you feel better."

"Would you like to talk about what you are feeling?"

The child with leukemia is to receive a unit of platelets.The child weighs 33 lbs. and the platelets are to be infused at 10mL/kg/hr. The nurse should plan to infuse the platelets at a rate of how many milliliters per hour? __________________ mL/hr (Record your answer as a whole number.)

150

The nurse is educating a group of clients about detection and prevention of cancer. Which of the following is not a form of prevention of cancer? Adjunct prevention Tertiary prevention Primary prevention secondary preventio

Adjunct prevention

The nurse is caring for the toddler 8 hours post-injury. The toddler has second-and third-degree burns over 20% of the body. Which is the most critical nursing problem that the nurse should ensure is included in the child's plan of care? Impaired physical mobility. Imbalanced nutrition; less than body requirements. Risk for imbalanced body temperature. Deficient fluid volume.

Deficient fluid volume. Deficit fluid volume from hypovolemia is the most critical nursing problem. During the first 6-24 hours after injury, plasma oozes from the vascular space into the burn site.

A client diagnosed with a terminal illness appoints her oldest son as the authorized individual to make medical decisions on her behalf when she is no longer able to speak for herself. Which proxy directive is the patient using? Medical directive by proxy Living will declaration Durable power of attorney for health care End-of-life treatment directive

Durable power of attorney for health care

The nurse is assessing a toddler diagnosed with acute otitis media (AOM). Which signs and symptoms should the nurse expect? Select all that apply. Fussy, restless Irritable, crying Pulling at the affected ear(s) Rhinitis, cough, severe diarrhea Rolls head from side to side

Fussy, restless Irritable, crying Pulling at the affected ear(s) Rolls head from side to side

A client newly diagnosed with cancer is scheduled to begin chemotherapy treatment and the nurse is providing anticipatory guidance about potential adverse effects. When addressing the most common adverse effect, what should the nurse describe? Pruritis (itching) Nausea and vomiting Altered glucose metabolism Confusion

Nausea and vomiting

Which of the following will be abnormal in a child with the diagnosis of hemophilia? Platelet count Hemoglobin level White blood count Partial thromboplastin time (PTT)

Partial thromboplastin time (PTT) The abnormal laboratory results in hemophilia are related to decreased clotting function. Partial thromboplastin time is prolonged.Platelets are normal, as is the hemoglobin (it will drop with bleeding),WBC count does not change with hemophiilia

A nurse is caring for a client with a terminal illness. The client asks the nurse to help him end his own life to alleviate his suffering and that of his family. When responding to the client, the nurse integrates knowledge of which of the following? Participating in assisted suicide violates the Code of Ethics for Nurses. Nurses may administer medications prescribed by physicians to hasten end of life. A client has the right to make independent decisions about the timing of his or her death. Most states have enacted laws that allow for physician-assisted suicide.

Participating in assisted suicide violates the Code of Ethics for Nurses.

The child is presenting with burn injuries. What should be the nurse's priority during the initial assessment? The location, extent, and shape of burn injuries. The parent's concerns regarding the child's burn. Signs of smoke inhalation and airway patency. The child's history of other illnesses or infections.

Signs of smoke inhalation and airway patency. Assessment of the ABC's is priority. It is imperative to ensure that the airway has not been compromised by smoke or edema related to neck and facial burns.

Which of the following activities should a nurse suggest for an adolescent diagnosed with hemophilia? Select all that apply. Golf Hiking Fishing Soccer Swimming

Swimming Golf Hiking Fishing

According to Kubler Ross, there are 5 stages of grief. What are they?

The 5 stages of grief are: Anger, Denial, Bargaining, Denial and Acceptance.

The client is diagnosed with cancer and is receiving chemotherapy. The nurse should assess which diagnostic value while the client is receiving chemotherapy? bone marrow cells liver tissues heart tissues pancreatic enzymes

bone marrow cells The fast-growing normal cells most likely to be affected by certain cancer treatments are blood-forming cells in the bone marrow, as well as cells in the digestive track, reproductive system and hair follicles.

A patient diagnosed with terminal pancreatic cancer is unaware of the diagnosis and his daughter has requested that he not be told. What awareness context does the nurse determine this is? suspected awareness closed awareness open awareness mutual pretense awareness

closed awareness

The nurse is caring for a 10-year-old with leukemia who is receiving chemotherapy. The child is on neutropenic precautions. Friends of the child come to the desk and ask for a vase for the flowers they have brought with them. Which of the following is the best response? "I will get you a special vase we use on this unit." "The flowers from your garden are beautiful but should not be placed in the room at this time." "As soon as I can wash a vase, I will put the flowers in it and bring it to the room." "Get rid of the flowers immediately.You could harm the child."

"The flowers from your garden are beautiful but should not be placed in the room at this time." A neutropenic client should not have flowers in the room because the flowers may harbor Aspergillus or Pseudomonas aeruginosa. Neutropenic children are susceptable to infection. Precautions need to be taken so that the child does not come in contact with any potential sources of infection. Fresh fruits and vegetables can also harbor molds and should be avoided. Telling the friend the flowers are beautiful but that that the child cannot have them is a tactful way to not offend the friend.

The nurse is presenting information about conjunctivitis to parents of preschool children. Which statement from a parent indicates understanding of the most important point about bacterial conjunctivitis? "Conjunctivitis is almost always self-limiting wiithout treatment" "The most common cause of conjunctivitis is from a foreign body." "Washcloths and towels should be used only by the infected person." "Conjunctivitis can be transmitted to the newborn during the birth process."

"Washcloths and towels should be used only by the infected person." Washcloths and towels used by the infected person should be kept separtate from others. Bacterial conjunctivitis can be easily transmitted to family members and others in direct contact with the child. Tissues used should be disposed of immediately, and good hand washing techniques should be followed by everyone.

The mother of the pediatric client consults the nurse because her daughter, who has alopecia from chemotherapy, refuses to wear the wig that she wants her to wear. The mother states she feels uncomfortable when people stare at her daughter. Which response is most appropriate? s your daughter refusing to wear the wig because you are trying to make her wear it?" "Does your daughter feel uncomfortable when others are looking at her hairless head?" "You seem concerned about people staring. Tell me more about what you are feeling." "Your daughter should cover her head when exposed to sunlight, wind or the cold

"You seem concerned about people staring. Tell me more about what you are feeling." Hair loss is often a greater problem for the parents than the child. The parent may be grieving the loss of the normal child. Acknowledging the parent's feelings and focusing the communication on the parent use the therapeutic communication technique of a broad opening statement.

The parents of a 3-month-old ask why their baby will not have an operation to correct a ventricular septal defect(VSD). The nurse's best response is: "It is always helpful to get a second opinion about any serious condition like this." "Your baby's defect is small and will likely close on its own by 1 year of age." "Ir is common for health-care-providers to wait until an infant develops respiratory distress before they do the surgery." "With a small defect like this, they wait until the child is 10 years old to do the surgery.

"Your baby's defect is small and will likely close on its own by 1 year of age." Usually a VSD will close on its own within the first year of life.

The parents of the child with sickle cell anemia are being taught pain control measures for their child. Which measure is most important to teach the parents to prevent the onset of vaso-occlusive pain? Apply ice packs to all joints as soon as the child awakens. Encourage drinking large amounts of fluids every day. Administer acetaminophen 1000 mg orally twice daily. Increase outdoor exercise in the fresh air and sunshine.

Encourage drinking large amounts of fluids every day. 2- Hydration promotes hemodilution, reduces blood viscosity, and prevents vessel occlusion. The information is most important to teach parents. exercise increases O2 demand , decreases oxygen tension, and increases sickling. Sunshine exposure can lead to dehydration, which increases blood viscosity. Tylenol is useful for pain but the dosage is excessive for a child Ice packs cause vasoconstriction , increasing pain and sickling

The nurse assesses that extravasation of a chemotherapy agent has occurred. What is the nurse's initial action? Discontinue the infusion Apply a warm compress to the area. Inject an antidote, if required. Place ice over the site of infiltration

Discontinue the infusion The first or initial response by the nurse would be to stop the infusion.

Which of the following is the best method to prevent the spread of infection to an immunosuppressed child? Administer antibiotics prophylactically to the child. Have people wash their hands prior to contact with the child. Assign the same nurses to care for the child each day. Limit visitors to family members only.

Have people wash their hands prior to contact with the child. Handwashing is the best method to prevent the spread of germs and protect the child from infection.

The nurse is feeding the infant with heart failure. Which intervention should the nurse implement? Hold the infant at a 45-degree angle for feeding. Burp the infant only after the feeding is completed. Space feedings six hours apart to reduce fatigue. Administer feedings only through a feeding tube.

Hold the infant at a 45-degree angle for feeding. 1-The infant with HF should be placed at a 45-degree angle during feedings. This angle decreases venous return of blood volume to the heart and eases the stress of feeding. infant should be burped often and allowed breaks to prevent fatigue during feedings Feedings should occur more frequentily due to fatigue rather than further apart A feeding tube is used only if the infant is unable to nipple feed or has tachypnea during feedings.

A client is newly diagnosed with cancer and is beginning a treatment plan. Which action by the nurse will be most effective in helping the client cope? Assume decision making for the client until treatment is completed Encourage the client to observe strict compliance with all treatment regimens Inform the client of all possible adverse treatment effects Identify available resources for the client and family

Identify available resources for the client and family identifying available resources for the client and family represents a respectful effort to make options available and encourages the client to become involved in treatment decisions.

Which is a sign of approaching death? Clear sensorium Increase in urinary output Insomnia Irregular breathing patterns

Irregular breathing patterns

Which of the following is the most common opportunistic infection in children infected with human immunodeficiency virus(HIV)? CMV Encephalitis Meningitis Pneumocystic pneumonia

Pneumocystic pneumonia Pneumocystis jiroveci pneumonia is the most common opportunistic infection that can occur in HIV-infected children, and such children are treated prophylactically for this

The nurse assesses the hospitalized child with severe burn injuries on the lower extremities. Findings include weak distal pulses in the right leg with capillary refill >3 seconds, and the child reports feeling numbness and tingling in the right leg. What should be the nurse's conclusion regarding this information? This is to be expected during the initial phase of burn healing. This is an emergency situation, and the HCP should be notified. Comparative assessment of the extremity in 1 hour is necessary. Fluid accumulation under the burn scab is decreasing blood flow.

This is an emergency situation, and the HCP should be notified. 2- The findings suggest inadequate circulation and impairment of nerve function, possibly from the tough, leathery scab (eschar). The eschar can form a tight constricting band, and an escharotomy may need to be performed by the HCP. these are not expected finding during any phase of burn healing Waiting an hour to do a comparative assessment will delay treatment. This is not a fluid accumulation but an emergency situation due to constriction from the eschar.

Tetralogy of Fallot (TOF) involves which defects? Select all that apply. Ventricular septal defect (VSD) Right ventricular hypertrophy Left ventricular hypertrophy Pulmonic valve stenosis (PS) Pulmonic atresia Overriding aorta Patent ductus arteriousus (PDA)

Ventricular septal defect (VSD) Right ventricular hypertrophy Pulmonic valve stenosis (PS) Overriding aorta

The client who is receiving chemotherapy is not eating well but otherwise feels healthy. What should the nurse suggest the client eat? cereal with milk and strawberries toast, gelatin dessert, and cookies broiled chicken, green beans and cottage cheese steak and french fries

broiled chicken, green beans and cottage cheese Carbohydrates are the first substance used by the body for energy. Proteins are needed to maintain muscle mass, repair tissue, and maintain osmotic pressure in the vascular system. Fats, in a small amount, are needed for energy production. Chicken, green beans and cottage cheese are the best selection to provide a nutritionally well-balanced diet of carbs, protein and a small amount of fat.

The nurse is caring for a child diagnosed with acute lymphoblastic leukemia (ALL) who is receiving chemotherapy. The nurse notes that the child's platelet count is 20,000/mm3. Based on this laboratory finding, what information should the nurse provide to the child and parents? A soft toothbrush should be used for mouth care Isolation precautions should be started immediately The child's vital signs, including blood pressure, should be monitored every 4 hours. All visitors should be discouraged from coming to see the family.

A soft toothbrush should be used for mouth care Because the platelet count is decreased, there is a significant risk of bleeding, especially in soft tissue. The use of a soft toothbrush should help prevent bleeding of the gums.

The child diagnosed with thrombocytopenia purpura is being discharged from the hospital. Which nursing intervention is most important? Teach parents to offer frozen juice pops to increase the child's fluid intake. Inform the parents to keep flowers away from the child's living space. Apply firm pressure to the IV site for 5 minutes after it's removal. Flush the IV line with normal saline before removing the peripheral catheter

Apply firm pressure to the IV site for 5 minutes after it's removal. The nurse should apply firm pressure to the site for at least 5 minutes after discontinuing the IV because the client is at increased risk for bleeding due to decrease platelets.

When explaining hospice care to a client, the nurse should tell the client: Hospice are uses a team approach to direct hospice activity Clients and their families are the focus of care Your healthcare provider coordinates all the care All hospice clients will die at home

Clients and their families are the focus of care The most important central component of hospice care is focus of care on the client as well as the family or significant other.

The nurse is suctioning the pediatric client who just had cardiac surgery. The nurse observes tachypnea, the use of accessory muscles to breath, and restlessness. Which action should be taken by the nurse? Continue suctioning; these are expected findings during the procedure. Continue suctioning but monitor closely, as these could be signs of distress. Discontinue suctioning, carefully monitor the client, and notify the HCP. Discontinue suctioning, notify HCP, and prepare for chest tube insertion.

Discontinue suctioning, carefully monitor the client, and notify the HCP.

The ED nurse is assessing the pediatric client with a tentative diagnosis of acute pericarditis. Which assessment finding should the nurse conclude supports acute pericarditis? Bilateral lower-extremity pain Pain on expiration Pleural friction rub Pericardial friction rub

Pericardial friction rub 4- inflammation of the pericardial sac from acute pericarditis produces a pericardial friction rub. Pain on inspiration not expiration with pericarditis decreased perfusion to extremities can cause pain in extremities but does not occur with pericarditis.

What would the nurse do first for a 5-year-old girl with profound bradycardia? Provide oxygen at 100% Administer epinephrine as ordered Use warming blankets Perform gastric lavage

Provide oxygen at 100% CHD is often found in children with Down syndrome. The other 3 options are not associated with Down syndrome

Aspirin has been ordered for the child with rheumatic fever (RF) in order to: Keep the patient ductus arteriosus (PDA) open Reduce joint inflammation Decrease swelling of strawberry tongue Treat ventricular hypertrophy of endocarditis

Reduce joint inflammation Joint inflammation is experienced in rheumatic fever; aspirin therapy helps with inflammation and pain.

Which of the following factors need(s) to be included in a teaching plan for a child with sickle cell disease? Select all that apply. The child needs to be taken to a physician when sick. The parent should make sure the child sleeps in an air-conditioned room. Emotional stress should be avoided It is important to keep the child well hydrated. It is important to make sure the child gets adequate nutrition.

The child needs to be taken to a physician when sick. Emotional stress should be avoided It is important to keep the child well hydrated. It is important to make sure the child gets adequate nutrition.

The parent of a child diagnosed with Wilms tumor asks the nurse what the treatment plan will be. The nurse explains the usual protocol for this condition. Which information should the nurse give to the parent? The child will have chemotherapy and after that had been completed, radiation. The child will need to have surgery to remove the tumor. The child will go to surgery for the removal of the tumor and the kidney and will then start chemotherapy. The child will need radiation and later surgery to remove the tumor.

The child will go to surgery for the removal of the tumor and the kidney and will then start chemotherapy. Combination therapy of surgery and chemotherapy is the primary therapeutic management. Radiation is done depending on clinical stage and histological pattern.

The 2-year-old child has a bulky dressing in place over 60% of the child's body following a skin grafting procedure for a severe burn injury. The parents arrive to visit the child and are shocked to see the child's appearance. What is the nurse's most caring action? Help the parents don the mask, gown, and gloves that are needed to enter the child's room. Bring the parents to a quiet place to allow the parents to talk about immediate concerns. When appropriately attired, accompany the parents to show them how to touch their child. Arrange for a member of the clergy to come visit with the parents and child for support.

When appropriately attired, accompany the parents to show them how to touch their child.

The nurse is teaching the client who is receiving chemotherapy and the family how to manage possible nausea and vomiting at home. The nurse should include information about: eating frequent, small meals throughout the day eating three normal meals a day eating only cold foods with no odor limiting the amount of fluid intake

eating frequent, small meals throughout the day Dietary suggestions to reduce adverse effects of cancer and cancer therapies include a soft, bland diet low in fat and sugar. Frequent, small meals are usually better tolerated.

A client with cancer who is receiving radiation therapy develops thrombocytopenia. The priority nursing goal is to prevent: pain related to spontaneous bleeding altered nutrition related to anemia injury related to the decreased platelet count skin breakdown related to decreased tissue perfusion

injury related to the decreased platelet count This client is at high risk for bleeding because of the decreased platelet count. The priority nursing goal is to prevent injury to this client by preventing bleeding occurrences.

The nurse is discussing primary cancer prevention with a group of clients. Which of the following is considered primary prevention and would be included in her discussion? monitoring and preventing recurrence of cancer and the development of secondary malignancies screening and early detection activities that identify precancerous lesions and early-stage cancers in patients who lack signs and symptoms of cancer reduction of risks of disease through health promotion and risk reduction strategies such as in the use of immunizations community based screening and detection programs

reduction of risks of disease through health promotion and risk reduction strategies such as in the use of immunizations Primary prevention is about reducing the risks of disease through health promotion and risk reduction strategies. An example would be the use of immunizations.

A client who is receiving chemotherapy develops stomatitis. What should the nurse instruct the client to do? rinse the mouth with full-strength hydrogen peroxide every 4 hours use a soft-bristled toothbrush after each meal drink hot tea with honey to soothe the painful oral mucosa avoid using dental floss until the stomatitis is resolved

use a soft-bristled toothbrush after each meal

When preparing to administer a chemotherapeutic agent to a client, the nurse should: recap all needles used to prepare agents dispose of chemotherapy wastes in the client's bedside trash use gloves and disposable long sleeved gowns when handling agents administer only prepackaged agents from the manufacturer

use gloves and disposable long sleeved gowns when handling agents Chemotherapeutic agents are very toxic: therefore, precautions are taken such as the use of gloves and long-sleeved gowns when handling agents to prevent incidental contact with skin.