NURS 355 Chapter 31
A parent tells the nurse that 80% of children with the same type of leukemia as his son's have a 5-year survival. He believes that because another child on the same protocol as his son has just died, his son now has a better chance of success. What is the best response by the nurse?
"Each child has an 80% likelihood of 5-year survival."
The nurse is caring for a 6-year-old child with acute lymphoblastic leukemia (ALL). The parent states, "My child has a low platelet count, and we are being discharged this afternoon. What do I need to do at home?" What statement is most appropriate for the nurse to make?
"Your child should avoid contact sports or activities that could cause bleeding."
A child with cancer being treated with chemotherapy is receiving a platelet transfusion. The nurse understands that the transfused platelets should survive the body for how many days?
1-3 days
What specific gravity of the urine is desired so that hemorrhagic cystitis is prevented?
1.005
Calculate the absolute neutrophil count (ANC) for the following: WBC count of 5000 mm3; neutrophils (segs) of 10%; and nonsegmented neutrophils (bands) of 12%.
1100/mm3
Daily toothbrushing and flossing can be encouraged for the child on chemotherapy when the platelet count is above which?
40,000/mm3
What type of chemotherapeutic agent alters the function of cells by replacing a hydrogen atom of a molecule?
Alkylating agents
What strategies should the nurse implement to increase nutritional intake for the child receiving chemotherapy?
Allow the child any food tolerated Fortify foods with nutritious supplements Allow the child to be involved in food selection
An adolescent is scheduled for a leg amputation in 2 days for treatment of osteosarcoma. What approach should the nurse implement?
Answer questions with straightforward honesty.
The nurse should teach the family that which residual disabilities can occur for a child being treated for a brain tumor?
Ataxia Dysphagia Sensory deficits Cranial nerve palsies
What are favorable prognostic criteria for acute lymphoblastic leukemia?
CALLA positive Early pre-B cell 2-10 years of age
A child with leukemia is receiving intrathecal chemotherapy to prevent which condition?
CNS disease
A child has been diagnosed with a Wilms tumor. What should preoperative nursing care include?
Careful bathing and handling
The nurse is collecting a 24-hour urine sample on a child with suspected diagnosis of neuroblastoma. What finding in the urine is expected with neuroblastomas?
Catecholamines
The nurse is caring for a child with retinoblastoma that was treated with an enucleation. What interventions should the nurse plan for care of an eye socket after enucleation?
Change the eye pad daily Irrigate the socket daily with a prescribed solution Apply a prescribed antibiotic ointment after irrigation
What pain management approach is most effective for a child who is having a bone marrow test?
Conscious or unconscious sedation
The nurse is caring for a child receiving chemotherapy for leukemia. The child's granulocyte count is 600/mm3 and platelet count is 45,000/mm3. What oral care should the nurse recommend for this child?
Daily toothbrushing and flossing
What chemotherapeutic agent is classified as an antitumor antibiotic?
Daunorubicin (cerubidine)
A child is receiving vincristine (Oncovin). The nurse should monitor for which side effect of this medication?
Diarrhea
What is an important priority in dealing with the child suspected of having Wilms tumor?
Ensuring the abdomen is protected from palpation
As part of the diagnostic evaluation of a child with cancer, biopsies are important for staging. What statement explains what staging means?
Extent of the disease at the time of prognosis
The parents of a child with cancer tell the nurse that a bone marrow transplant (BMT) may be necessary. What information should the nurse recognize as important when discussing this with the family?
Finding a suitable donor involves matching antigens from the human leukocyte antigen (HLA) system.
Postoperative positioning for a child who has had a medulloblastoma brain tumor (infratentorial) removed should be which?
Flat, on either side with pillows behind the back
A child has an absolute neutrophil count (ANC) of 500/mm3. The nurse should expect to be administering which prescribed treatment?
G-CSF (neupogen) daily
A child with osteosarcoma is experiencing phantom limb pain after an amputation. What prescribed medication is effective for short-term phantom pain relief?
Gabapentin (neurontin)
A school-age child with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time. What is the most appropriate nursing action to prevent or minimize these reactions with subsequent treatments?
Give an antiemetic before chemotherapy begins.
The nurse is preparing a child for possible alopecia from chemotherapy. What information should the nurse include?
Hair may have a slightly different color or texture when it regrows.
What are the most common clinical manifestations of brain tumors in children?
Headaches and vomiting
After chemotherapy is begun for a child with acute leukemia, prophylaxis to prevent acute tumor lysis syndrome includes which therapeutic intervention?
Hydration
An adolescent will receive a bone marrow transplant (BMT). The nurse should explain that the bone marrow will be administered by which method?
IV infusion
The nurse should expect to care for which age of child if the admitting diagnosis is retinoblastoma?
Infant or toddler
What chemotherapeutic agent can cause an anaphylactic reaction?
L-Asparagnase (elspar)
What immunization should not be given to a child receiving chemotherapy for cancer?
Measles, mumps, rubella (MMR)
Essential postoperative nursing management of a child after removal of a brain tumor includes which nursing care?
Measuring all fluid intake and output
Chemotherapeutic agents are classified according to what feature?
Mechanism of action
In teaching parents how to minimize or prevent bleeding episodes when the child is myelosuppressed, the nurse includes what information?
Meticulous mouth care is essential to avoid mucositis.
What is appropriate mouth care for a toddler with mucosal ulceration related to chemotherapy?
Mouthwashes with plain saline
One pediatric oncologic emergency is acute tumor lysis syndrome. Symptoms that this may be occurring include what?
Muscle cramps and tetany
What is a common clinical manifestation of Hodgkin disease?
Non-tender enlargement of lymph nodes
Total-body irradiation is indicated for what reason?
Preparation for bone marrow transplant
What guidelines should the nurse follow when handling chemotherapeutic agents?
Prepare medications in a safety cabinet Wear gloves designed for handling chemotherapy Wear face and eye protection when splashing is possible Discard gloves and protective clothing in a special container
What statement related to clinical trials developed for pediatric cancers is most accurate?
Provide the best available therapy compared with an expected improvement
A young child with leukemia has anorexia and severe stomatitis. What approach should the nurse suggest that the parents try?
Relax any eating pressures.
The mother of an infant tells the nurse that sometimes there is a whitish "glow" in the pupil of his eye. The nurse should suspect which condition?
Retinoblastoma
What childhood cancer may demonstrate patterns of inheritance that suggest a familial basis?
Retinoblastoma
The nurse is administering an intravenous chemotherapeutic agent to a child with leukemia. The child suddenly begins to wheeze and have severe urticaria. What nursing action is most appropriate to initiate?
Stop the drug infusion immediately
The nurse is precepting a new graduate nurse at an ambulatory pediatric hematology and oncology clinic. What cardinal signs of cancer in children should the nurse make the new nurse aware of?
Sudden tendency to bruise easily Frequent headaches Unexplained loss of energy
What side effect commonly occurs with corticosteroid (prednisone) therapy?
Susceptibility to infection
A parent of a hospitalized child on chemotherapy asks the nurse if a sibling of the hospitalized child should receive the varicella vaccination. The nurse should give which response?
The sibling can get a varicella vaccination
What description identifies the pathophysiology of leukemia?
Unrestricted proliferation of immature white blood cells (WBCs)
Nursing care of the child with myelosuppression from leukemia or chemotherapeutic agents should include which therapeutic intervention?
Use good hand-washing technique
A 5-year-old child is being prepared for surgery to remove a brain tumor. Preparation for surgery should be based on which information?
Usually the postoperative dressing covers the entire scalp.
A child on chemotherapy has developed rectal ulcers. What interventions should the nurse teach to the child and parents to relieve the discomfort of rectal ulcers?
Warm sitz baths Use of stool softeners Record bowel movements Occlusive ointment applied to the area
A child, age 10 years, has a neuroblastoma and is in the hospital for additional chemotherapy treatments. What laboratory values are most likely this child's?
White blood cell count, 3,000/mm3; hemoglobin, 11.5 g/dl
