Chapter 25: The Child with Cancer ANS
A toddler with leukemia is on intravenous chemotherapy treatments. The toddler's lab results are WBC: 1000; neutrophils: 7%; nonsegmented neutrophils (bands): 7%. What is this child's absolute neutrophil count (ANC)? (Record your answer in a whole number.)
140
4. A clinic nurse is conducting a staff in-service for other clinic nurses about signs and symptoms of a rhabdomyosarcoma tumor. Which should be included in the teaching session? (Select all that apply.)
Abdominal mass Sore throat and ear pain Ecchymosis of conjunctiva
17. The nurse is admitting a child with a Wilms tumor. Which is the initial assessment finding associated with this tumor?
Abdominal swelling
12. A school-age child 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?
Administer an antiemetic before chemotherapy begins.
7. A young boy will receive a bone marrow transplant (BMT). This is possible because one of his older siblings is a histocompatible donor. Which is this type of BMT called?
Allogeneic
26. The nurse is caring for an adolescent with osteosarcoma being admitted to undergo chemotherapy. The adolescent had a right above-the-knee amputation 2 months ago and has been experiencing "phantom limb pain." Which prescribed medication is appropriate to administer to relieve phantom limb pain?
Amitriptyline (Elavil)
25. An adolescent with osteosarcoma is scheduled for a leg amputation in 2 days. The nurse's approach should include which action?
Answering questions with straightforward honesty
4. A boy with leukemia screams whenever he needs to be turned or moved. Which is the most probable cause of this pain?
Bone involvement
21. The nurse is monitoring a 7-year-old child post surgical resection of an infratentorial brain tumor. Which vital sign findings indicate Cushing's triad?
Bradycardia, hypertension, irregular respirations
6. A child with leukemia is receiving triple intrathecal chemotherapy consisting of methotrexate, cytarabine, and hydrocortisone. What will the triple intrathecal chemotherapy prevent?
Central nervous system (CNS) disease
1. The nurse is preparing to give oral care to a school-age child with mucositis secondary to chemotherapy administered to treat leukemia. Which preparations should the nurse use for oral care on this child? (Select all that apply.)
Chlorhexidine gluconate (Peridex) Antifungal troches (lozenges) Lip balm (Aquaphor)
30. The home health nurse is caring for a child who requires complex care. The family expresses frustration related to obtaining accurate information about their child's illness and its management. Which is the best action for the nurse?
Clarify family's request, and provide information they want.
8. Which is the most effective pain-management approach for a child who is having a bone marrow aspiration?
Conscious or unconscious sedation
20. The nurse is teaching nursing students about childhood nervous system tumors. Which best describes a neuroblastoma?
Diagnosis is usually made after metastasis occurs.
15. Which is a common clinical manifestation of Hodgkin disease?
Enlarged, firm, nontender lymph nodes
14. The nurse is preparing a child for possible alopecia from chemotherapy. Which should be included?
Explain to child that when hair regrows, it may have a slightly different color or texture.
28. The home health nurse asks a child's mother many questions as part of the assessment. The mother answers many questions and then stops and says, "I don't know why you ask me all this. Who gets to know this information?" The nurse should take which action?
Explain who will have access to the information.
23. A nurse is conducting a staff in-service on childhood cancers. Which is the primary site of osteosarcoma?
Femur
2. Which is the usual presenting symptom for testicular cancer?
Hard, painless mass
18. What is the most common clinical manifestation(s) of brain tumors in children?
Headaches and vomiting
16. An adolescent will receive a bone marrow transplant (BMT). The nurse should explain that the bone marrow will be administered by which route?
IV infusion
33. The home care nurse has been visiting an adolescent with recently acquired tetraplegia. The teen's mother tells the nurse, "I'm sick of providing all the care while my husband does whatever he wants to, whenever he wants to do it." Which should be the initial action of the nurse?
Listen and reflect mother's feelings.
9. Which immunization should not be given to a child receiving chemotherapy for cancer?
Measles, rubella, mumps
22. In which position should the nurse place a 10-year-old child after a large tumor was removed through a supratentorial craniotomy?
On the inoperative side with the head of bed elevated 20 to 30 degrees
10. Which is often administered to prevent or control hemorrhage in a child with cancer?
Platelets
27. Home care is being considered for a young child who is ventilator-dependent. Which factor is most important in deciding whether home care is appropriate?
Preparation and training of family
13. A young child with leukemia has anorexia and severe stomatitis. The nurse should suggest that the parents try which intervention?
Relax any eating pressures.
11. The nurse is administering an IV chemotherapeutic agent to a child with leukemia. The child suddenly begins to wheeze and have severe urticaria. Which is the most appropriate nursing action?
Stop drug infusion immediately.
3. The treatment of brain tumors in children consists of which therapies? (Select all that apply.)
Surgery Chemotherapy Radiation
1. The school nurse is discussing testicular self-examination with adolescent boys. Why is this important?
Testicular tumors during adolescence are generally malignant.
2. 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.)
The face may be edematous or ecchymotic. There will be an eye pad dressing taped over the surgical site. The implanted sphere is covered with conjunctiva and resembles the lining of the mouth.
35. A ventilator-dependent child is cared for at home by his parents. Nurses come for 4 hours each day giving the parents some relief. Which other strategy should the nurse recommend to give the parents a break from the responsibilities of caring for a ventilator-dependent child?
Train a trusted grandparent to provide an occasional break from the responsibilities of care.
24. 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?
Treatment usually consists of surgery and chemotherapy.
3. Which is most descriptive of the pathophysiology of leukemia?
Unrestricted proliferation of immature white blood cells (WBCs) occurs.
19. A 5-year-old boy is being prepared for surgery to remove a brain tumor. Nursing actions should be based on which statement?
Usually the postoperative dressing covers the entire scalp.
31. A family wants to begin oral feeding of their 4-year-old son, who is ventilator-dependent and currently tube-fed. They ask the home health nurse to feed him the baby food orally. The nurse recognizes a high risk of aspiration and an already compromised respiratory status. The most appropriate nursing action is to:
acknowledge their request, explain the risks, and explore with the family the available options.
32. One of the supervisors for a home health agency asks the nurse to give the family a survey evaluating the nurses and other service providers. The nurse should recognize this as:
appropriate to improve quality of care.
34. A mother of a 5-year-old child, with complex health care needs and cared for at home, expresses anxiety about attending a kindergarten graduation exercise of a neighbor's child. The mother says, "I wish it could be my child graduating from kindergarten." The nurse recognizes that the mother is experiencing:
chronic sorrow.
5. Myelosuppression, associated with chemotherapeutic agents or some malignancies such as leukemia, can cause bleeding tendencies because of a(n):
decrease in blood platelets.
29. When communicating with other professionals, it is important for home care nurses to:
restrict communication to clinically relevant information.
