Pediatric Cancer NCLEX Questions

"Nursing considerations related to the administration of chemotherapeutic drugs include which of the following? "a) Anaphylaxis cannot occur, since the drugs are considered toxic to normal cells. b) Infiltration will not occur unless superficial veins are used for the intravenous infusion. c) Many chemotherapeutic agents are vesicants that can cause severe cellular damage if drug infiltrates. d) Good hand washing is essential when handling chemotherapeutic drugs, but gloves are not necessary."

"CORRECT c. Chemotherapeutic agents can be extremely damaging to cells. Nurses experienced with the administration of vesicant drugs should be responsible for giving these drugs and be prepared to treat extravasations if necessary. a. Anaphylaxis is a possibility with some chemotherapeutic and immunologic agents. b. Infiltration and extravasations are always a risk, especially with peripheral veins. d. Gloves are worn to protect the nurse when handling the drugs, and the hands should be thoroughly washed afterward."

"After teaching the parents of a child newly diagnosed with leukemia about the disease, which of the following descriptions given by the mother best indicates that she understands the nature of leukemia?" "A) ""The disease is an infection resulting in increased white blood cell production."" B) ""The disease is a type of cancer characterized by an increase in immature white blood cells."" C) ""The disease is an inflammation associated with enlargement of the lymph nodes."" D) ""The disease is an allergic disorder involving increased circulating antibodies in the blood."""

"CORRECT: B. Leukemia is a neoplastic, or cancerous, disorder of blood-forming tissues that is characterized by a proliferation of immature white blood cells."

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

"Correct answer: A Signs of infiltration of the bone marrow are petechiae from lowered platelet count, fever related to infection from the depressed number of effective leukocytes, and fatigue from the anemia. The other options are not signs of bone marrow involvement."

"A child with cancer has the following lab result: WBC 10,000, RBC 5, and plts of 20,000. When planning this child's care, which risk should the nurse consider most significant? "A. Hemorrage B. Anemia C. Infection D. Pain"

"Correct answer: A Hemorrhage The lab values presented all are normal except for the platelet count. Decreases in platelet counts place the child at greatest risk for hemorrhage."

"A preschool-age child undergoing chemotherapy experiences nausea and vomiting. Which of the following would be the best intervention to include in the child's plan of care? "a. Administer tube feedings. b. Offer small, frequent meals. c. Offer fluids only between meals. d. Allow the child to choose what to eat for meals."

"Correct answer: D While all options can be done to encourage nutrition, allowing the preschooler choices meets two issues: nutrition and developmental tasks."

"A 9-year old child with leukemia is in remission and has returned to school. The school nurse calls the mother of the child and tells the mother that a classmate has just been diagnosed with chickenpox. The mother immediately calls the clinic nurse because the leukemic child has never had chickenpox. The appropriate response by the clinic nurse to the mother is: "1. There is no need to be concerned. 2. Bring the child into the clinic for a vaccine. 3. Keep the child out of school for 2 week period. 4. Monitor the child for an elevated temperature, and call the clinic if this happens."

"Correct anwser: 2. Rationale: immunocompromised children are unable to fight varicella adequately. Chickenpox can be deadly to the them. If the child who has not had chickenpox is exposed to someone with varicella, the child should receive varicella zoster immune globulin within 96hrs of exposure. Options 1,3,4, are incorrect because they do nothing to minimize the chances of developing the disease."

A nurse analyzes the lab values of a child with leukemia who is receiving chemotherapy. The nurse notices that the platelet count is 19,500 cell/mm3. Based on this lab value which intervention would the nurse document in her plan of care. " "1. Monitor closely for signs of infection. 2. Temp every four hours. 3. Isolation precautions 4. Use a small toothbrush for mouth care"

4. **Correct... Rationale: Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production. If the platelet count is les than 20,000 than bleeding precautions need to be taken.

A child with leukemia is being discharged after beginning chemotherapy. Which of the following instructions will the nurse include when teaching the parents of this child? "A. provide a diet low in protein and high in carboydrates B. avoid fresh vegetables that are not cooked or peeled C. notify the doctor if the child's temp exceeds 101 degrees F D. increase the use of humidifiers throughout the house"

Answer B - fresh vegetables harbor microorganisms, which can cause infections in immune-compromised children, fruit or vegetables should be either peeled or cooked. The physician should be notified of a temp above 100 degrees F. A diet low in protein is not indicated. Humidifiers harbor fungi in the water containers.

When caring for an 11-month-old infant with dehydration and metabolic acidosis, the nurse expects to see which of the following? "a. A reduced white blood cell count b. A decreased platelet count c. Shallow respirations d. Tachypnea"

Answer D. The body compensates for metabolic acidosis via the respiratory system, which tries to eliminate the buffered acids by increasing alveolar ventilation through deep, rapid respirations, altered white blood cell or platelet counts are not specific signs of metabolic imbalance.

The nurse understands a primary step toward achievement of a long range goal associated with the rehabilitation of a client with a new colostomy is: "A. Mastery of techniques of colostomy care B. Readiness to accept an altered body function C. Awareness of available community resources D.Knowledge of the neccessary dietary modifications.

"ANSWER: B The client must be ready to accept changes in body image and function; this acceptance will facilitate mastery of the techniques of colosotomy care and optimal use of community resources."

A preschool-aged child is to undergo several painful procedures. Which of the following techniques is most-appropriate for the nurse to use in preparing the child? "A. Allow the child to practice injections on a favorite doll. B. Explain the procedure in simple terms. C. Allow a family member to explain the procedure to the child. D. Allow the child to watch an educational video."

"Answer: B Preschoolers have the cognitive ability to understand simple terms. Use of a favorite doll is contraindicated because it is ""part"" of that child and he/she might perceive the doll is experiencing pain."

"The postoperative care of a preschool child who has had a brain tumor removed should include which of the following? "a. colorless drainage is to be expected b. analgesics are contraindicated because of altered consciousness c. positioning is on the operative side in the Trendelenberg position d. carefully monitor fluids due to cerebral edema"

"D CORRECT: Because of cerebral edema and the danger of increased intracranial pressure postoperatively, fluids are carefully monitored. A. Colorless drainage may be leakage of cerebrospinal fluid from the incision site. This needs to be reported as soon as possible. B. Analgesics can be used for postoperative pain. C. Child should not be positioned in Trendelenburg position postoperatively."

A child being treated for Acute Lymphocytic Leukemia (ALL) has a white blood cell (WBC) count of 7,000/mm3. the nursing care plan lists risk for infection as a priority nursing diagnosis, and measures are being taken to reduce the child's exposure to infection. the nurse determines that the plan has been successful when which outcome has been met? "1. child's WBC count goes up. 2. child's WBC count goes down. 3. child's temperature remains within normal range. 4. parents demonstrate good hand washing technique."

CORRECT is #3 - RATIONALE: in leukemia, the WBCs that are present are immature and incapable of fighting infection. increases or decreases in the number of WBCs can be related to the disease process and treatment, and not related to infection. the only value that indicates the child is infection-free is the temperature. the use of proper handwashing technique is a measure or intervention used to meet a goal. but is not a goal itself. STRATEGY: the core issue of the question is knowledge of an indicator of infection in a client who is immunosuppressed from leukemia. recall that temperature and WBC counts are frequently used as indicators of infection. recall that in leukemia the WBCs are abnormal so choose the option related to temperature.

"A 15-year-old has been admitted to the hospital with the diagnosis of acute lymphocytic leukemia. Which of the following signs and symptoms require the most immediate nursing intervention? (Choices were deleted)

Correct: 2. Fever and petechiae associated with acute lymphocytic leukemia indicate a suppression of normal white blood cells and thrombocytes by the bone marrow and put the client at risk for other infections and bleeding. The nurse should initiate infection control and safety precautions to reduce these risks. Fatigue is a common symptom of leukemia due to red blood cell suppression. Although the client should be told about the need for rest and meal planning, such teaching is not the priority intervention. Swollen glands and lethargy may be uncomfortable but they do not require immediate intervention. An enlarged liver and spleen do require safety precautions that prevent injury to the abdomen; however, these precautions are not the priority.

"Chemotherapy dosage is frequently based on total body surFace area (BSA), so it is important for the nurse to do which of the following before administering chemotherapy? "1. Measure abdominal girth 2. Claculate BMI 3. Ask the client about his/her height and weight 4. Weigh and measure the client on the day of medication administration"

"Answer: 4 To ensure that the client receives optimal doses of chemotherapy, dosing is usually based on the total Body surface area(BSA) which requires accurate height and weight before each med administration. Simply asking the client about height/weight may lead to inaccuracies in determining BSA. Calculating BMI and measuring abdominal girth does not provide the data needed."

"Which nursing diagnosis is highest-priority for a child undergoing chemotherapy and experiencing nausea and vomiting? "A. Fluid and Electrolyte Imbalance B. Alterations in Nutrition C. Alterations in Skin Integrity D. Body Image Disturbances"

"Correct Answer: A While all of the nursing diagnoses listed here are important, dehydration and fluid and electrolyte loss secondary to vomiting is the priority for this client."

"A 10 year old child with hemophilia A has slipped on the ice and bumped his knee. The nurse should prepare to administer an: "A. injection of factor X B. intravenous infusion of iron C. intravenous infusion of factor VIII D. intramuscular injection of iron using the Z track method"

"CORRECT: C Hemophila refers to a group of bleeding disorders resulting from a deficiency of specific coagulation proteins. the primary meds used are to replace missing clotting factor. Factor VIII will be prescribed intravenously to replace the missing clotting factor and minimize the bleeding,"

"The mother of a child diagnosed with a potentially life-threatening form of cancer says to the nurse, ""I don't understand how this could happen to us. We have been so careful to make sure our child is healthy."" Which response by the nurse is most appropriate? "A. ""This must be a difficult time for you and your family. Would you like to talk about how you are feeling?"" B. ""Why do you say that? Do you think that you could have prevented this?"" C. ""You shouldn't feel that you could have prevented the cancer. It is not your fault."" D. ""Many children are diagnosed with cancer. It is not always life-threatening."""

"Correct Answer: A Parents of children diagnosed with cancer require major emotional support, and should be allowed to express their feelings. Prevention and blaming oneself is not supportive, nor is telling the parents that there are many other children with cancer."

"After a client is admitted to the pediatric unit with a diagnosis of acute lymphocytic leukemia, the laboratory test indicates that the client is neutropenic. The nurse should perform which of the following? "a. Advise the client to rest and avoid exertion b. Prevent client exposure to infections c. Monitor the blood pressure frequently d. Observe for increased bruising"

"Correct Answer: B. Prevent client exposure to infections Rationale: Neutropenia is a decreased number of neutrophil cells in the blood which are responsible for the body's defense against infection. Rest and avoid exertion would be related to erythrocytes and oxygen carrying properties. Monitoring the blood pressure, and observing for bruising would be related to platelets and sign and symptoms of bleeding."

The nurse is completing a care plan for a client diagnosed with leukemia. Which independent problem should be addressed? "1.Infection. 2.Anemia. 3.Nutrition. 4.Grieving."

"Correct: 4. Grieving is an independent problem, and the nurse can assess and treat this problem with or without collaboration."

"The parent of a child undergoing chemotherapy asks the nurse why the child must wear a mask in public places. Which of the following responses by the nurse would be most appropriate? "A) ""Chemotherapy causes dry mouth, and the mask will help contain moisture."" B) ""Chemotherapy decreases immune system function, increasing the risk of acquiring an infection."" C) ""Chemotherapy makes the oral mucous membranes deteriorate and makes them susceptible to infection."" D) ""Chemotherapy kills cancer cells, and your child might spread those cells to others."""

"Correct: B Chemotherapeutic agents decrease the immunity of the child. Proper use of the mask will decrease the chance of acquiring an infection. Cancer is not spread; a mask cannot contain moisture; and unsightly mouth sores are not a medical reason to wear a mask."

What are the needs of the patient with acute lymphocytic leukemia and thrombocytopenia? "(A) to a private room so she will not infect other patients and health care workers (B) to a private room so she will not be infected by other patients and health care workers (C) to a semiprivate room so she will have stimulation during her hospitalization (D to a semiprivate room so she will have the opportunity to express her feelings about her illness "

"Correct: B. a-— poses little or no threat B(CORRECT:)- protects patient from exogenous bacteria, risk for developing infection from others due to depressed WBC count, alters ability to fight infection c-— should be placed in a room alone d-ensure that patient is provided with opportunities to express feelings about illness"