Ch 53: Nursing Care of a Family when a Child has a Malignancy
b) It is important to monitor for late effects Pg. Numerous children survive childhood cancer. Risks for late effects of earlier disease and treatment require monitoring, prevention, and/or treatment for life. Psychosocial health, cancer research, and support groups are all important but do not represent the rationale for informing an adult health care provider of childhood cancer.
30. The nurse is instructing a childhood cancer survivor, now 20 years old, on the need to inform future health care providers of their prior disease and treatments. Which rationale is included in the instruction? a) It provides access to community support groups b) It is important to monitor for late effects c) It can explain psychosocial health issues d) The ability to participate in cancer research
a) Urine catecholamine metabolites, homovanillic acid (HVA), and vanillylmandelic acid (VMA) Pg.
36. The nurse is preparing clients for diagnostic testing for cancer. Which test is used to differentiate a neuroblastoma from other tumors? a) Urine catecholamine metabolites, homovanillic acid (HVA), and vanillylmandelic acid (VMA) b) Serum chemistries c) Complete blood count (CBC) with differential d) Urinalysis
b) Body appearance changes very little Pg. 1513 An implanted port has nothing extending through the skin and may be obvious only as a slight protrusion at the insertion site. Some tunneling from the port to a central vein is needed. Removal of the port requires a surgical procedure. Flushing of the port is necessary when used and on a regular basis.
8. What is one advantage of an implanted port (central venous access device) that the nurse will explain to an adolescent? a) Flushing of the device is not necessary b) Body appearance changes very little c) No tunneling is needed when the port is inserted d) No special procedure is necessary for removal
b) Severe bone pain Pg. 1521 Osteosarcoma typically is characterized by dull bone pain that may be present for several months, eventually progressing to limp or gait changes. The affected limb may exhibit erythema and swelling, warmth, and tenderness.
13. The nurse is assessing an adolescent with suspected osteosarcoma. What would the nurse be least likely to assess? a) Swelling of the extremity b) Severe bone pain c) Erythema of the extremity d) Gait changes
a) Vaccination for the human papilloma virus Pg. 1501 Reminding parents that both boys and girls should receive the vaccine against human papillomavirus (HPV) is an important preventive measure to reduce the incidence of cervical cancer. Smoking is associated with lung cancer, and sunburn (from lack of sunscreen or other protection from the sun) is associated with skin cancer. Consumption of animal fats is not associated with cervical cancer.
35. The mother of a 13-year-old adolescent is concerned about her daughter getting cervical cancer later in life and asks the nurse if there are any ways to reduce the risk. Which would the nurse recommend? a) Vaccination for the human papillomavirus b) A diet free from animal fats c) Insist that the daughter wear SPF 30 sunscreen while outside d) Urging the daughter to not begin smoking
d) Keeping the child pain-free Pg. 1512 Children die from cancer. They may die at home or in the hospital, and hospice care can be provided in either setting. Children with terminal cancer often experience a great deal of pain, particularly when death is imminent. The primary goal of caring for a dying child is the prevention and alleviation of pain. The nurse would work with the parents to determine the pharmacologic and nonpharmacologic methods which work best. Many times, dyspnea and agitation can occur as a result of pain. These symptoms are reduced with pain management. Any care to the child, even in hospice care, should be developmentally appropriate. Emotional support is a necessity, both for the child and the parents, but pain relief is the priority.
32. A child with cancer is dying and in hospice care. When developing the plan of care, which intervention should the nurse include as the primary focus? a) Providing emotional support b) Delivering appropriate developmental care c) Managing the symptoms of dyspnea d) Keeping the child pain-free
c) Ewing sarcoma Pg. 1521-1522 Radiographs that show lesions on the bone may indicate tumors (e.g., Ewing sarcoma, osteosarcoma) or metastasis of tumors. Osteosarcoma is the most common type of bone malignancy in children. It occurs primarily in the long bones. Ewing sarcoma is a highly malignant bone cancer. It occurs in the pelvis, chest wall, vertebrae, and midshaft of the long bones. Neuroblastomas are seen in children younger than 5 years old and arise from immature nerve cells and the adrenal glands. Hodgkin disease develops from the immune system. Non-Hodgkin lymphoma is a blood cancer.
11. The pediatric nurse examines the radiographs of a client that indicate lesions on the bone. This finding is indicative of: a) Neuroblastoma b) Non-Hodgkin lymphoma c) Ewing sarcoma d) Hodgkin disease
b) Encourage the adolescent to select hats or wigs to fit one's personality Pg.
37. An adolescent receiving chemotherapy has lost all hair and is sad about self-image. Which action should the nurse take to support this adolescent and involve the client in decision making? a) Refer the adolescent to a peer support group b) Encourage the adolescent to select hats or wigs to fit one's personality c) Support the adolescent's choice of comfortable clothing d) Have a Child Life specialist work with the adolescent
b) Protect the abdomen from manipulation Pg. 1524 Manipulation can release malignant cells into the abdominal cavity. Constipation may be a problem following surgical intervention. Pain is uncommon; obtaining a urine specimen is not a priority.
10. What is the priority action the nurse should take when caring for a child newly diagnosed with Wilms tumor (nephroblastoma)? a) Obtain a catheterized urine specimen b) Protect the abdomen from manipulation c) Control acute pain d) Assess for constipation
c) Bladder Pg. 1502 The most common sites for childhood cancer include the blood, lymph, brain, bone, kidney, and muscle. Bladder is a common site for adult cancer.
20. A group of nursing students are studying information about childhood cancers in preparation for a class examination. They are reviewing how childhood cancers differ from adult cancers. The group demonstrates understanding of the information when they identify what location as an unlikely site for childhood cancer? a) Kidney b) Brain c) Bladder d) Blood
b) Lethargy, bruises, and lymphadenopathy Pg. 1503, 1526 Although all of these symptoms could be related to leukemia, the most likely are lethargy, bruises, and lymphadenopathy. Joint pain and swelling could also be juvenile arthritis or another disorder. Anorexia and weight loss are fairly nonspecific, as is abdominal pain, nausea, and vomiting. With ALL, because the bone marrow overproduces lymphocytes and therefore is unable to continue normal production of other blood components, the first symptoms of ALL in children usually are those associated with decreased RBC production (anemia) such as pallor, low-grade fever, and lethargy. A low thrombocyte (platelet) count will lead to petechiae and bleeding from oral mucous membranes and cause easy bruising on arms and legs. As the spleen and liver begin to enlarge from infiltration of abnormal cells, abdominal pain, vomiting, and anorexia occur. As abnormal lymphocytes invade the bone periosteum, the child experiences bone and joint pain. Central nervous system (CNS) invasion leads to symptoms such as headache or unsteady gait. On physical assessment, painless, generalized swelling of lymph nodes is revealed.
26. A 5-year-old child is at the pediatric clinic for a well-child visit. Which symptom alerts the health care provider that this child might have acute lymphoblastic leukemia (ALL)? a) Anorexia and weight loss b) Lethargy, bruises, and lymphadenopathy c) Abdominal pain, nausea, and vomiting d) Joint pain and swelling
b) Placing a "no abdominal palpation" sign above the child's bed Pg. 1524 Nephroblastoma (Wilms tumor) metastasizes rapidly, so it is important that the child's abdomen not be palpated any more than necessary for diagnosis, because handling appears to aid metastasis. There is no need to restrict the child's visitors. Ensuring nothing by mouth would be appropriate prior to surgery. Preventing weight-bearing activities would be appropriate for a child with Ewing sarcoma.
17. A nurse is providing care to a toddler with nephroblastoma and is being evaluated. Which nursing action would be most important? a) Preparing the child for chemotherapy b) Placing a "no abdominal palpation" sign above the child's bed c) Restricting the child's visitors d) Preventing weight-bearing activities e) Ensuring that the child be allowed nothing by mouth
b) Administering the measles, mumps, rubella (MMR) vaccine Pg. 1501, 1507, 1511 Live vaccines (viral or bacterial) should not be administered to an immunosuppressed child because of the risk of causing disease. The other health maintenance activities are important for the health maintenance of the toddler and should be included during the well-child visit.
22. The toddler with a cancer diagnosis is seen for a well-child checkup. Which health maintenance activity will the nurse exclude? a) Plotting height and weight on a growth chart b) Administering the measles, mumps, rubella (MMR) vaccine c) Teaching the importance of taking water safety measures d) Assessing dietary intake by addressing "picky eating" and "food jags"
b) Head c) Neck d) Extremities Pg. 1523 The most common locations for rhabdomyosarcoma are the head and neck, genitourinary tract, and extremities.
29. A nurse is preparing a presentation for a parent group on childhood cancers. As part of the presentation, the nurse plans to discuss rhabdomyosarcoma. What are some common sites where rhabdomyosarcoma occurs? Select all that apply. a) Gastrointestinal tract b) Head c) Neck d) Extremities e) Central nervous system
c) "The cancer cells have spread to the lymph nodes" Pg. 1504 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.
6. 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? a) "This means that the tumor has not extended into surrounding tissue" b) "This means there is some local spread, but complete surgical removal is possible" c) "The cancer cells have spread to the lymph nodes" d) "The cancer has spread to other organs"
a) Provide various soft and bland foods to minimize further irritation b) Apply a lip balm or petroleum jelly to prevent cracking e) Have the child rinse the mouth with lukewarm water three times a day Pg. 1510 For the child with stomatitis, the nurse should provide soft foods to prevent further abrasions, have the child rinse the mouth three times a day with lukewarm water to promote comfort and healing, avoid giving the child acidic foods that would further irritate the tissue, and apply a lip balm or petroleum jelly to prevent cracking of the lips. The nurse should offer a soft toothbrush to minimize discomfort.
7. A child is receiving chemotherapy and develops stomatitis. The nurse identifies a nursing diagnosis of Impaired oral mucous membranes related to the effects of chemotherapy. What instructions would the nurse include in the child's plan of care? Select all that apply. a) Provide various soft and bland foods to minimize further irritation b) Apply a lip balm or petroleum jelly to prevent cracking c) Vigorously rub the child's gums with gauze to clean them d) Give the child acidic foods (e.g., orange juice) to cleanse the mouth e) Have the child rinse the mouth with lukewarm water three times a day
a) "I know this is scary, but leukemia has a high cure rate in children these days" Pg. 1513 Although cancer in children is rare compared to unintentional injury or infection, it is the leading medical cause of death among persons younger than 25 years of age. Fortunately, the overall survival rate for children with cancer today has improved. The overall 5-year survival rate is 84.5%, and for acute lymphoblastic leukemia (the most common form of childhood cancer), the 5-year survival is 88.5%
18. 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? a) "I know this is scary, but leukemia has a high cure rate in children these days" b) "I don't blame you for being upset; any parent would be scared too" c) "Don't worry, the health care provider is very good at treating leukemia" d) "You are very lucky to have caught it so early; that makes the treatments easier"
c) Nausea and erythema Pg. 1504 Radiation sickness (fatigue, anorexia, nausea, vomiting) is the most frequently encountered systemic effect. Skin reactions, such as erythema and tenderness, are typical local effects. Vomiting and alopecia are typical side effects of chemotherapy. Children receiving external radiation are not radioactive. Fatigue is a side effect of radiation, but bone demineralization is not. Asymmetric bone growth is more likely.
25. A child with a sarcoma is receiving external beam radiation. Which possible side effect will the nurse need to explain to parents? a) Fatigue and bone demineralization b) Vomiting and alopecia c) Nausea and erythema d) Radioactivity for up to 4 days
d) Most childhood cancers affect the tissues rather than organs Pg. 1502 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.
27. 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? a) Unlike adult cancers, childhood cancers are less responsive to treatment b) Childhood cancers are usually localized when found c) The majority of childhood cancers can be prevented d) Most childhood cancers affect the tissues rather than organs
a) "Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system" Pg. 1514 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.
12. Parents ask why their child just diagnosed with leukemia needs a "spinal tap." Which is the best response by the nurse? a) "Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central nervous system" b) "It will help rule out a second malignancy" c) "The spinal tap will help relieve pressure and headache for your child" d) "A sample of cerebrospinal fluid is needed to check for possible central nervous system infection"
a) Administer the antiemetic before starting chemotherapy Pg. 1519 Antiemetics are most effective when given before chemotherapy begins and then on a regular schedule to prevent nausea and vomiting throughout administration of chemotherapy. Nonpharmacologic measures can be used in conjunction with antiemetics but not in place of them.
14. Antiemetics are ordered to control nausea and vomiting in the child undergoing chemotherapy. How can the nurse most effectively use these medications? a) Administer the antiemetic before starting chemotherapy b) Start the antiemetic on a scheduled basis when the chemotherapy begins to cause nausea c) Provide the antiemetic as needed (PRN) when nausea and vomiting are reported d) Use the antiemetic after it is clear that nonpharmacologic methods are not effective
d) Call it a tumor of muscle tissue Pg. 1523 A rhabdomyosarcoma is a tumor of striated muscle that most commonly develops in the head, neck, arms, and legs, as well as in the genitourinary tract, of children.
15. How can the nurse most simply describe for distressed parents a rhabdomyosarcoma that has been found in their 5-year-old? a) Indicate that the more commonly used name is Hodgkin lymphoma b) Describe it as a bone tumor c) Explain that it develops in nerves outside the brain and spinal cord d) Call it a tumor of muscle tissue
b) Cells are only susceptible to treatment by radiation during certain phases of the cell cycle Pg. 1504 Radiation is not effective on cells that have a low oxygen content (a proportion of cells in every tumor), nor is it effective at the time of cell division (mitosis). Therefore, radiation schedules are designed so that therapy occurs over a period of 1 to 6 weeks and includes time intervals when cells will be in a susceptible stage.
16. The father of an 8-year-old boy who is receiving radiation therapy is upset that his son has to go through 6 weeks of treatments. He doesn't understand why it takes so long. In explaining the need for radiation over such a long time, what should the nurse mention? a) Insurance companies typically allow only a short radiation treatment per week, to contain costs b) Cells are only susceptible to treatment by radiation during certain phases of the cell cycle c) It is difficult to locate where the cancer cells are in the body, so the entire body must be irradiated d) Radiation therapy is very weak, and therefore it takes a long time to achieve therapeutic doses
a) 0930 Pg. 1509 Chemotherapeutic agents frequently have nausea and vomiting as a side effect of the treatment. Ondansetron is a common antiemetic agent, which blocks central and peripheral serotonin receptor sites to prevent chemotherapy-induced nausea. Ondansetron should be given 30 minutes before beginning chemotherapy. For this child, the correct time would be 0930. Giving it at 0700, 0830, or 0900 would not allow the full therapeutic benefit for the child.
24. A child is receiving chemotherapy. The chemotherapy is scheduled to begin at 1000. To prevent nausea and vomiting, the child is prescribed ondansetron. At what time will the nurse administer the medication? a) 0930 b) 0700 c) 0830 d) 0900
d) School nurse providing a session on sun protection for children Pg. 1500 Because childhood cancers do not typically arise from environmental contaminants like most adult cancers do, methods to reduce the risk are not as well defined. Urging parents to reduce children's exposure to secondary cigarette smoke and counseling children and adolescents not to begin smoking, including the use of tobacco alternatives and electronic cigarettes, can help reduce the incidence of several cancers in adulthood. Although it is not yet known how much sunscreen actually reduces the risk of melanoma, applying sunscreen, reducing the overall time of sun exposure, and avoiding tanning salons are measures to help reduce the development of skin cancer in later life.
19. Which nursing action promotes prevention of malignancies in children? a) School nurse screening for vision, hearing, and scoliosis b) Pediatric nurse monitoring lab values on child diagnosed with leukemia c) Clinic nurse plotting child's growth on a standardized growth chart d) School nurse providing a session on sun protection for children
b) Have the parent bring the child to the pediatric oncology clinic as soon as possible Pg. 1501, 1507, 1514 The preschooler is considered immunosuppressed following recent chemotherapy. A fever can mean sepsis, which would require immediate investigation of blood and other body fluids to identify the organism, plus prompt treatment with an IV antibiotic. This can be accomplished only by seeing the pediatric oncologist and is likely to result in hospitalization.
2. A preschooler who received chemotherapy in the pediatric oncology outpatient department 1 week ago now has a temperature of 101.5°F (38.6°C). Which is the most appropriate response by the nurse? a) Instruct the parent to immediately obtain and give the antibiotic that the oncologist will order b) Have the parent bring the child to the pediatric oncology clinic as soon as possible c) Tell the parent to administer acetaminophen every 4 hours until the fever dissipates d) Ask whether any family members or other close associates are ill
c) Having the child sleep in a single bed and room d) Encouraging frequent, thorough handwashing Pg. 1511 To reduce the risk of infection, the nurse should teach the child and parents about minimizing the child's exposure to potentially infectious situations. The nurse should encourage the parents to arrange for the child to sleep in a single bed and room and, if possible, avoid close contact with other family members who may be developing upper respiratory tract infections. Thorough and frequent handwashing, especially after using the bathroom and before eating, is essential. A high-calorie, high-protein diet helps to rebuild white blood cells and should be encouraged. If possible, the child's exposure to large crowds and visitors should be limited because of the increased risk of infection from these individuals. Fresh flowers and plants should be avoided because they could harbor mold spores.
21. The nurse identifies that the client is at risk for an infection related to chemotherapy-induced immunosuppression. What would the nurse include in the teaching plan for the child and parents about reducing the child's risk? Select all that apply. a) Providing a low-carbohydrate, low-protein diet b) Encouraging frequent close contact with numerous visitors c) Having the child sleep in a single bed and room d) Encouraging frequent, thorough handwashing e) Cheering up the environment with fresh flowers and plants
a) Headache, vision changes, and vomiting Pg. 1517 Children with any form of brain tumor develop symptoms of increased intracranial pressure: headache, vision changes, vomiting, an enlarging head circumference, or papilledema. Lethargy, projectile vomiting, and coma are late signs. Epistaxis is not usually related to a brain tumor. A growing tumor produces specific localized signs, such as nystagmus (constant horizontal movement of the eye) or visual field defects. As tumor growth continues, symptoms of ataxia, personality change (e.g., emotional lability, irritability), and seizures may occur. These would be later symptoms.
23. A school nurse is teaching a group of parents about signs and symptoms of cancer in children. Which symptom is an early sign of a brain tumor? a) Headache, vision changes, and vomiting b) Nystagmus, ataxia, and seizures c) Headache, epistaxis, and dizziness d) Projectile vomiting, lethargy, and coma
a) Limit sun exposure throughout childhood and adolescence Pg. 1525 Limiting sun exposure by using shade, clothing, and sunscreen applied correctly will reduce the risk of skin cancer. Sun exposure is cumulative throughout life; the greatest exposure tends to occur in childhood and adolescence. Tanning booths should not be used. The other choices could have some merit, but none has been scientifically confirmed.
28. What is a well-defined risk management technique that the nurse can teach children and parents to prevent cancer? a) Limit sun exposure throughout childhood and adolescence b) Incorporate more preservative-free foods into the diet c) Eliminate aerosol sprays from the living area d) Avoid artificial colors, flavors, and fragrances in foods, cosmetics, and household items
d) Child reports facial palsy and vision problems Pg. 1513-1514 The presence of facial palsy and vision problems indicates that the central nervous system has been infiltrated by leukemia cells. The petechiae, purpura, or unusual bruising result from decreased platelet levels and may be present regardless of metastasis. Adventitious breath sounds may indicate pneumonia and may be present whether the disease has metastasized or not. Hepatomegaly and splenomegaly result from infection, not metastasis.
3. The nurse is assessing a 10-year-old girl with acute lymphoblastic leukemia. What information would lead the nurse to suspect that the cancer has infiltrated the central nervous system? a) Observing petechiae, purpura, or unusual bruising b) Palpation of abdomen reveals enlarged liver and spleen c) Noting adventitious breath sounds during auscultation d) Child reports facial palsy and vision problems
b) No routine live vaccines are administered while on chemotherapy Pg. 1501 Children with cancer need much of the same well-child maintenance care that all children do, with one exception. While they are undergoing chemotherapy, which causes a decreased immune response, they should not receive "routine" vaccines, especially live vaccines. The siblings in the home can receive all nonlive vaccines, and the entire family (including the child undergoing treatment) is encouraged to receive a yearly flu vaccine. Growth and development are monitored during well-child visits, but it is not necessarily true that growth and development may be stunted. It is always a good idea to eliminate second-hand smoke for all children, not just for children with cancer. Childhood cancers do not seem to be related to environmental contaminants.
31. The pediatric nurse is explaining to a new graduate nurse the differences in planning well-child maintenance for a child with cancer. Which statement by the new nurse demonstrates understanding of the teaching? a) Growth may be stunted due to chemotherapy b) No routine live vaccines are administered while on chemotherapy c) Eliminate second-hand smoke within the home d) Siblings and parents should not receive nonlive vaccines
d) Reed-Sternberg cells Pg. 1515 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.
33. A child is undergoing a series of diagnostic tests for a suspected malignancy. Which diagnostic test result is only present in Hodgkin disease? a) Elevated lymphocytes b) T-lymphocyte surface markers c) Megakaryocyte cells d) Reed-Sternberg cells
b) Practice frequent, gentle oral hygiene Pg. 1507, 1510 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.
34. Which intervention is best to use with the 6-year-old who has developed stomatitis as a side effect of chemotherapy? a) Use lidocaine rinses b) Practice frequent, gentle oral hygiene c) Limit foods to cool, clear liquids d) Have the child freely choose desired foods and beverages
b) Infection symptoms Pg. 1511 The neutrophils are the primary means of fighting bacterial infection. When the neutrophil count is very low, the child has the potential to have an overwhelming bacterial infection. The child is at the greatest risk when the neutrophil count is less than 500/µL (0.50 ×109/L). The nurse's priority would be to assess for signs and symptoms of infection. A bacterial infection can be life-threatening for this child. This child would be placed in neutropenic precautions. This is a form of isolation where the child is protected from health care workers and outside visitors. Among other precautions, no plants or raw fruits or vegetables would be allowed in the room, and the child should have no rectal examinations or medications and not experience a urinary catheterization. To prevent an infection, the nurse would administer broad spectrum antibiotics. The vital signs should be assessed every 4 hours, and alterations could indicate more problems than just infection. Mucositis occurs when there is an ulcerated oral mucosa. It should be assessed but is not the priority. Bleeding would be more related to low platelet count and not neutrophils.
4. A child with cancer has developed neutropenia and is in isolation with neutropenic precautions. What nursing assessment takes priority for this child? a) Vital signs b) Infection symptoms c) Bleeding d) Mucositis
c) Abdominal palpation Pg. 1524 Abdominal palpation is contraindicated preoperatively in a client with a Wilms tumor. Cells may break loose and spread the tumor. Intravenous fluids and supine positioning are appropriate in the client's care. A Foley catheter is typically not placed.
1. The nurse is caring for a pediatric client who is scheduled for the surgical removal of a Wilms tumor. Which action is contraindicated in the client's care? a) Foley catheter placement b) Intravenous fluids c) Abdominal palpation d) Supine positioning
b) Cushingoid facies Pg. Although other effects such as vomiting, constipation, and mucositis are possible with chemotherapy, children receiving long-term corticosteroid therapy (e.g. dexamethasone or prednisone) develop a typical "moon face," red cheeks, and a stocky build. Like the loss of hair, a Cushingoid appearance can be devastating to children or parents, the final insult in light of all the other things happening to them.
5. A child diagnosed with a malignancy is receiving long-term corticosteroid therapy as part of the chemotherapy regimen. The nurse would be especially alert for the development of which effect? a) Constipation b) Cushingoid facies c) Mucositis d) Vomiting
d) Avoiding further abdominal palpation Pg. 1524 After the initial assessment is performed on a child with Wilms tumor, further palpation of the abdomen should be avoided because the tumor is highly vascular and soft. Therefore, excessive handling of the tumor may result in tumor seeding and metastasis. Preoperatively, the child with Wilms tumor does not have a wound; therefore, dressing changes are not necessary. Although the child may experience abdominal pain, avoiding further abdominal palpation would be the priority. Surgical removal of the tumor and affected kidney is the treatment of choice for Wilms tumor. Amputation would be more likely for a child with osteosarcoma.
9. A 4-year-old child diagnosed with Wilms tumor is admitted for surgery. What information would be most important for the nurse to include in the child's preoperative plan of care? a) Performing dressing changes to the affected area b) Administering analgesics for pain c) Preparing the child for amputation d) Avoiding further abdominal palpation
