Peds Exam 2 Chapter 44; The Child With Cancer

The nurse is admitting a child with a Wilms' tumor. Which is the initial assessment finding associated with this tumor? a. Abdominal swelling b. Weight gain c. Hypotension d. Increased urinary output

a. Abdominal swelling

After chemotherapy is begun for a child with acute leukemia, prophylaxis to prevent acute tumor lysis syndrome includes which therapeutic intervention? a. Aggressive hydration b. Oxygenation c. Use of corticosteroids d. Aggressive pain management

a. Aggressive hydration

An adolescent with osteosarcoma is scheduled for a leg amputation in 2 days. The nurse's approach should include which action? a. Answering questions with straightforward honesty b. Avoiding discussing the seriousness of the condition c. Explaining that, although the amputation is difficult, it will cure the cancer d. Assisting the adolescent in accepting the amputation as better than a long course of chemotherapy

a. Answering questions with straightforward honesty

The nurse is discussing with the family and child undergoing removal of a brain tumor about the possibilities of residual disabilities that could occur postoperatively. Which of the following could be potential disabilities? Select all that apply. a. Ataxia b. Anorexia c. Sensory deficits d. Dysphagia e. Dysuria f. Intellectual deficits

a. Ataxia c. Sensory deficits d. Dysphagia f. Intellectual deficits

Anemia may be a side effect of chemotherapy treatment. Children with profound anemia should: a. Be allowed to regulate their physical activity with adult supervision. b. Be restricted in their physical activity. c. Receive blood transfusions of packed cells until their hemoglobin reaches 12 gm/dL. d. Be placed on strict bed rest with no physical activity until their hemoglobin level reaches 10 gm/dL.

a. Be allowed to regulate their physical activity with adult supervision.

A nurse is conducting a staff in-service on childhood cancers. Which is the primary site of osteosarcoma? a. Femur b. Humerus c. Pelvis d. Tibia

a. Femur

Which statement appropriately describes a neuroblastoma? a. It is considered to be a "silent" tumor. b. Early diagnosis is usually possible because of the obvious clinical manifestations. c. It is the most common brain tumor in young children. d. It is the most common benign tumor in young children.

a. It is considered to be a "silent" tumor.

A young child diagnosed with leukemia is experiencing anorexia and severe stomatitis. The nurse should suggest that the parents try which intervention? a. Relax any eating pressures b. Firmly insist that child eat normally c. Begin gavage feedings to supplement diet d. Serve foods that are either hot or cold

a. Relax any eating pressures

The nurse is administering an IV chemotherapeutic agent to a child diagnosed with leukemia. The child suddenly begins to wheeze and have severe urticaria. Which is the most appropriate nursing action? a. Stop drug infusion immediately. b. Recheck rate of drug infusion. c. Observe child closely for next 10 minutes. d. Explain to child that this is an expected side effect.

a. Stop drug infusion immediately.

The treatment of brain tumors in children consists of which therapies? (Select all that apply.) a. Surgery b. Bone marrow transplantation c. Chemotherapy d. Stem cell transplantation e. Radiation f. Myelography

a. Surgery c. Chemotherapy e. Radiation

The nurse is taking care of an adolescent with osteosarcoma. The parents ask the nurse about treatment. The nurse should make which accurate response about treatment for osteosarcoma? a. Treatment usually consists of surgery and chemotherapy. b. Amputation of the affected extremity is rarely necessary. c. Intensive irradiation is the primary treatment. d. Bone marrow transplantation offers the best chance of long-term survival.

a. Treatment usually consists of surgery and chemotherapy.

A clinic nurse is conducting a staff in-service for other clinic nurses about the signs and symptoms of a rhabdomyosarcoma tumor. Which should be included in the teaching session? (Select all that apply.) a. Bone fractures b. Abdominal mass c. Sore throat and ear pain d. Headache e. Ecchymosis of conjunctiva

b. Abdominal mass c. Sore throat and ear pain e. Ecchymosis of conjunctiva

A youngster will receive a bone marrow transplant (BMT) made possible because an older siblings is a histocompatible donor. Which is this type of BMT called? a. Syngeneic b. Allogeneic c. Monoclonal d. Autologous

b. Allogeneic

A 16-year-old girl presents to clinic with complaints of awakening with a headache and occasional vomiting not related to eating for the last month. What is most likely responsible for these clinical manifestations? a. A supratentorial tumor b. An infratentorial tumor c. A neuroblastoma d. A nephroblastoma

b. An infratentorial tumor

Which of the following are reasons to do a lumbar puncture on a child newly diagnosed with leukemia? Select all that apply. a. Rule out meningitis. b. Assess the central nervous system (CNS) for infiltration. c. Give intrathecal chemotherapy. d. Determine the presence of increased intracranial pressure. e. Stage the leukemia

b. Assess the central nervous system (CNS) for infiltration. c. Give intrathecal chemotherapy.

A boy with leukemia screams whenever he needs to be turned or moved. Which is the most probable cause of this pain? a. Edema b. Bone involvement c. Petechial hemorrhages d. Changes within the muscles

b. Bone involvement

Which is often administered to prevent or control hemorrhage in a child diagnosed with cancer? a. Nitrosoureas b. Platelets c. Whole blood d. Corticosteroids

b. Platelets

A 22-month-old child presents to clinic for a well-child checkup. The mother states to the provider, "I have noticed this 'white glow' in her left eye for the last 3 months and am not sure what it is." Based on this clinical manifestation the most likely disease process would be: a. Glioma tumor. b. Retinoblastoma. c. Optic nerve tumor. d. Rhabdomyosarcoma

b. Retinoblastoma.

1. Which expected appearance will the nurse explain to parents of an infant returning from surgery after an enucleation was performed to treat retinoblastoma? (Select all that apply.) a. A lot of drainage will come from the affected socket. b. The face may be edematous or ecchymotic. c. The eyelids will be sutured shut for the first week. d. There will be an eye pad dressing taped over the surgical site. e. The implanted sphere is covered with conjunctiva and resembles the lining of the mouth.

b. The face may be edematous or ecchymotic. d. There will be an eye pad dressing taped over the surgical site. e. The implanted sphere is covered with conjunctiva and resembles the lining of the mouth.

A 5 year old is being prepared for surgery to remove a brain tumor. Nursing actions should be based on which statement? a. Removal of tumor will stop the various symptoms. b. Usually the postoperative dressing covers the entire scalp. c. He is not old enough to be concerned about his head being shaved. d. He is not old enough to Comprehension the significance of the brain.

b. Usually the postoperative dressing covers the entire scalp.

A 3-year-old will be receiving his first dose of cisplatin as part of his treatment protocol. The nurse caring for this patient knows anaphylaxis is a potential complication. The nurse is aware the safe minimum time of observation for the possible development of anaphylaxis after administration would be: a. 30 minutes. b. 45 minutes. c. 60 minutes. d. 90 minutes

c. 60 minutes.

A school-age child diagnosed with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time. Which is the most appropriate nursing action to prevent or minimize these reactions with subsequent treatments? a. Encourage drinking large amounts of favorite fluids. b. Encourage child to take nothing by mouth (remain NPO) until nausea andvomiting subside. c. Administer an antiemetic at least 30 minutes before chemotherapy begins. d. Administer an antiemetic as soon as child has nausea.

c. Administer an antiemetic at least 30 minutes before chemotherapy begins.

What is the most common clinical manifestation(s) of brain tumors in children?a. Irritability b. Seizures c. Headaches and vomiting d. Fever and poor fine motor control

c. Headaches and vomiting

The nurse is providing postoperative care for a child following surgical removal of an infratentorial tumor. The nurse notes the child's pupils are now unequal and sluggish to react. Which of the following is the priority intervention at this time? a. Recheck the pupils in an hour. b. Reposition the patient to facilitate venous drainage. c. Notify the provider immediately. d. This is an expected finding after this type of surgical procedure.

c. Notify the provider immediately.

1. Which is most descriptive of the pathophysiology of leukemia? a. Increased blood viscosity occurs. b. Thrombocytopenia (excessive destruction of platelets) occurs. c. Unrestricted proliferation of immature white blood cells (WBCs) occurs. d. First stage of coagulation process is abnormally stimulated.

c. Unrestricted proliferation of immature white blood cells (WBCs) occurs.

Myelosuppression, associated with chemotherapeutic agents or some malignancies such as leukemia can cause bleeding tendencies because of what resulting outcome? a. Decrease in leukocytes b. Increase in lymphocytes c. Vitamin C deficiency d. Decrease in blood platelets

d. Decrease in blood platelets

Which is a common clinical manifestation of Hodgkin disease? a. Petechiae b. Bone and joint pain c. Painful, enlarged lymph nodes d. Enlarged, firm, nontender lymph nodes

d. Enlarged, firm, nontender lymph nodes

The nurse is preparing a child for possible alopecia from chemotherapy. Which intervention should be included? a. Explain to child that hair usually regrows in 1 year. b. Advise child to expose head to sunlight to minimize alopecia. c. Explain to child that wearing a hat or scarf is preferable to wearing a wig. d. Explain to child that when hair regrows, it may have a slightly different color or texture.

d. Explain to child that when hair regrows, it may have a slightly different color or texture.

Postoperative positioning for a child who has had a medulloblastoma brain tumor (infratentorial) removed should be which? a. Trendelenburg. b. Head of bed elevated 90 degrees. c. Flat on operative side with pillows behind the head. d. Flat on either side with pillows behind the back.

d. Flat on either side with pillows behind the back.

Nursing care of the child with myelosuppression from leukemia or chemotherapeutic agents should include which therapeutic intervention? a. Restrict oral intake of fluids. b. Institute strict isolation procedures. c. Give immunizations appropriate for age. d. Good handwashing.

d. Good handwashing.

Which immunization should be considered carefully before being given to a child receiving chemotherapy for cancer? a. Tetanus vaccine b. Inactivated poliovirus vaccine c. Diphtheria, pertussis, tetanus (DPT) d. Measles, rubella, mumps

d. Measles, rubella, mumps

In teaching parents how to minimize or prevent bleeding episodes when the child is myelosuppressed, the nurse includes what information? a. Rectal temperatures are necessary to monitor for infection b. Platelet transfusions are given to maintain a count greater than 45,000/mm³ c. Subcutaneous injections are preferred to intravenous ones. d. Meticulous mouthcare is essential to prevent mucositis

d. Meticulous mouthcare is essential to prevent mucositis