Pedi Exam 3: Chapter 26 Oncological Disorders
The nurse is preparing to post a sign above the crib of an infant with a Wilms tumor. Which statement should the nurse post immediately? A. "Do not palpate abdomen." B. "No intramuscular injections." C. "No milk or milk products allowed." D. "No blood sampling in lower extremities."
A. "Do not palpate abdomen."
A child receiving chemotherapy is experiencing significant reduction in red blood cells secondary to myelosuppression. Which agent would the nurse most likely expect to be ordered? A. Epoetin alfa B. Filgrastim C. Sargramostim D. Gamma interferon
A. Epoetin alfa
A child receiving chemotherapy wants to have a large birthday party and invite all the classmates. When the parent asks the nurse about this, what is the nurse's best response? A. "That will be a good way to cheer your child up!" B. "It is better to avoid large groups right now." C. "What about taking your child to a movie instead?" D. "We can have the party here in the hospital play room."
B. "It is better to avoid large groups right now."
A nurse is providing care to a 4-year-old child hospitalized with a diagnosis of acute lymphoblastic leukemia (ALL). The nurse has completed an assessment. Which finding should the nurse consider most concerning? A. Blood pressure 90/54 mm Hg B. Absolute neutrophil count = 400 mm3 (0.4 109/L) C. Poor appetite D. Temperature 101.2° F (38.4° C)
B. Absolute neutrophil count = 400 mm3 (0.4 x 109/L) An absolute neutrophil count (ANC) less than 500 mm3 (0.5 109/L) indicates a high risk of developing sepsis
A 6-month-old girl is seen with retinoblastoma. When taking a health history from her father, which symptom would you expect him to report he has noticed? A. The infant always keeps her eyes tightly closed. B. He has noticed one pupil appears white. C. His daughter tugs and pulls at one ear. D. His daughter's eye appears to be protruding
B. He has noticed one pupil appears white.
A child diagnosed with leukemia will receive chemotherapy as part of the treatment regimen. The nurse is providing teaching to the family about chemotherapy. Which statement by the family indicates that the teaching was effective? A. "Chemotherapy treatments for leukemia are usually completed within 4 to 6 weeks." B. "Once the first treatment is administered, the remaining treatments can be administered as an outpatient." C. "We can expect our child to experience hair loss, vomiting, and loss of appetite." D. "Side effects from these medications are usually minimal."
C. "We can expect our child to experience hair loss, vomiting, and loss of appetite.
A 4-year-old child is hospitalized with a diagnosis of leukemia and has received several chemotherapy treatments. The nurse providing care to the child has noticed changes in the child's condition and suspects the development of sepsis. Which assessment finding(s) should the nurse consider as most indicative of the onset of sepsis? Select all that apply. A. White blood cell (WBC) count of 40,000 uL (40 109/L) B. New-onset diarrhea C. Feet that are cool and mottled in color D. Persistent fever of 102.5° F (39.2° C) E. Capillary refill of 4 seconds
C. Feet that are cool and mottled in color D. Persistent fever of 102.5° F (39.2° C) E. Capillary refill of 4 seconds
A high-school football player has been diagnosed as having osteosarcoma of the femur. The parents are angry because they told the adolescent not to play football. Which health teaching points would the nurse include in the teaching plan for the adolescent and parents? A. Osteosarcoma often follows trauma, such as a football injury. B. You can expect some discoloration of the leg following chemotherapy. C. Football injuries do not contribute to the development of a tumor. D. Tumor growth is related to your dislike of milk.
C. Football injuries do not contribute to the development of a tumor.
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. Tell the parent to administer acetaminophen every 4 hours until the fever dissipates. B. Ask whether any family members or other close associates are ill. C. Have the parent bring the child to the pediatric oncology clinic as soon as possible. D. Instruct the parent to immediately obtain and give the antibiotic that the oncologist will order.
C. Have the parent bring the child to the pediatric oncology clinic as soon as possible.
A 16-year-old child suffering from alopecia related to chemotherapy treatment is refusing to let friends visit. Which action by the nurse is most appropriate? A. Respect the child's wishes and document refusal B. Have the parents explain the importance of letting friends visit C. Provide opportunities for the child to discuss his or her body image changes D. Allow friends to visit because socialization is important for adolescents
C. Provide opportunities for the child to discuss his or her body image changes
A nurse is providing discharge instructions to the parents of a child who has received chemotherapy treatments. The nurse is discussing infection prevention. Which statement by the parents indicates additional teaching is needed? A. "Good personal hygiene, especially hand washing, will help to prevent infection." B. "I will remind the pediatrician that my child cannot receive any live vaccines right now." C. "We will make sure our child is not exposed to anyone with a contagious illness." D. "My child has mouth sores from the chemotherapy, so I will take a rectal temperature if needed."
D. "My child has mouth sores from the chemotherapy, so I will take a rectal temperature if needed."
Pulse 100bpm, RR 22bpm, BP 90/56, T 99.1, Weight 95th percentile, height 68th percentile, visual acuity 20/30 OU. A parent brings the 4-year-old child to the clinic for a well visit. The nurse completes an assessment with the above findings. Based on the findings, what action should the nurse take? A. Document the findings as within normal limits. B. Refer the child to an ophthalmologist for further testing. C. Ask the parent if the child has had a fever recently. D. Make a note to the health care provider about the child's weight.
D. Make a note to the health care provider about the child's weight. This indicates that the child is heavier than average,
WBC 20,000, RBC 4.2, Hgb 10.5, HCT 29.9, PLT 85 A 4-year-old child is hospitalized with a diagnosis of leukemia. The nurse is reviewing the child's complete blood count (CBC) results as listed above. Which intervention should the nurse implement? A. Monitor the temperature every 8 hours. B. Wear a mask and gloves during direct client care. C. Prepare the child for transfusion with packed red cells. D. Monitor the child for signs of bleeding.
D. Monitor the child for signs of bleeding. A platelet count of 85 103/L (85 x 109/L) is far below the normal of 150-350 103/L (150-350 x 109/L) and indicates thrombocytopenia.
A 4-year-old child is hospitalized with a diagnosis of acute lymphoblastic leukemia (ALL). The child has received several chemotherapy treatments and has developed thrombocytopenia and neutropenia. Which intervention(s) should the nurse include in the plan of care? Select all that apply. A. Offer the child fresh fruit at meal times. B. Have the parent bring the child's favorite toothbrush for mouth care. C. Encourage the family to bring flowers to brighten the room. D. Restrict visitors who have a cough or other signs of illness or infection. E. Have the child wear a mask when outside of his or her room.
D. Restrict visitors who have a cough or other signs of illness or infection. E. Have the child wear a mask when outside of his or her room.
An adolescent is recovering from surgery, radiation, and chemotherapy following a diagnosis of Ewing sarcoma. Which statement by the family indicates that reteaching is needed? A. "Our child is looking forward to playing football again." B. "We will remind our child to care for the skin following radiation." C. "Our child's friends shaved their heads in solidarity to show their support." D. "We will watch for signs of infection and report it to our health care provider."
A. "Our child is looking forward to playing football again."
A 10-year-old who is receiving chemotherapy has received ondansetron before this therapy session. About an hour later, the child tells the nurse that his mouth feels really dry. The child has urinated several times and his skin turgor is normal. Which response by the nurse would be most appropriate? A. "The drug you got to help with the nausea can cause dry mouth." B. "Let me increase your intravenous fluids." C. "You might be having a severe allergic reaction. Are you itchy?" D. "This indicates an infection. We need to start antibiotics."
A. "The drug you got to help with the nausea can cause dry mouth."
A child is to receive an oral corticosteroid as part of the treatment regimen for leukemia. After teaching the child and family about this drug, the nurse determines the need for additional teaching when they state: A. "We should administer the drug on an empty stomach." B. "We should check our son's urine for glucose." C. "He might develop a rounded face from this drug." D. "We will need to gradually decrease the dosage."
A. "We should administer the drug on an empty stomach."
A 9-year-old child with leukemia is scheduled to undergo an allogenic hematopoietic stem cell transplant. When teaching the child and parents, what information would the nurse include? A. "We'll need to have a match to a donor." B. "The risk for rejection is much less with this type of transplant." C. "You won't need to receive the high doses of chemotherapy before the transplant." D. "You'll need to have an incision in your hip area to instill the cells."
A. "We'll need to have a match to a donor."
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. Provide the antiemetic as needed (PRN) when nausea and vomiting are reported C. Use the antiemetic after it is clear that nonpharmacologic methods are not effective D. Start the antiemetic on a scheduled basis when the chemotherapy begins to cause nausea
A. Administer the antiemetic before starting chemotherapy
A nurse is communicating with a family about palliative care. Which of the following would be the best approach to take? A. Ask the family what they know, what they wish to know and be prepared to repeat the information you give to them several times B. Give the family as much information as possible to promote better decision-making C. Provide information during a crisis when the parent's senses are heightened and memory is improved D. Avoid pushing the family by asking too many questions.
A. Ask the family what they know, what they wish to know and be prepared to repeat the information you give to them several times
The nurse is preparing a discharge teaching plan for the parents of an 8-year-old girl with leukemia. Which instruction would be the priority? A. Calling the doctor if the child gets a sore throat B. Keeping a written copy of the treatment plan C. Writing down phone numbers and appointments D. Using acetaminophen if the child needs an analgesic
A. Calling the doctor if the child gets a sore throat
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. Child reports of facial palsy and vision problems B. Observing petechiae, purpura, or unusual bruising C. Noting adventitious breath sounds during auscultation D. Palpation of abdomen reveals enlarged liver and spleen
A. Child reports of facial palsy and vision problems
The nurse identifies the nursing diagnosis of risk for 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. Having the child sleep in a single bed and room B. Encouraging frequent, thorough handwashing C. Providing a low-carbohydrate, low-protein diet D. Encouraging frequent close contact with numerous visitors E. Cheering up the environment with fresh flowers and plants
A. Having the child sleep in a single bed and room B. Encouraging frequent, thorough handwashing
A 4-year-old child diagnosed with acute lymphoblastic leukemia (ALL) is receiving chemotherapy. The nurse is reviewing the child's most recent laboratory results. Which result should alert the nurse that the child is at risk for sepsis? A. absolute neutrophil count 300/uL (0.30 109/L) B. white blood cell count 4900/uL (4.9 109/L) C. red blood cell count 4.0 x 106/uL (4.0 1012/L) D. hemoglobin 10.5 g/dL (105 g/L)
A. absolute neutrophil count 300/uL (0.30 109/L) An absolute neutrophil count (ANC) below 500/uL (0.5 109/L) indicates the child is at great risk of developing sepsis
A nurse is reviewing the laboratory results of a preschool child diagnosed with leukemia. The child is receiving chemotherapy and corticosteroids as part of the treatment regimen. What intervention is most important for the nurse to include in the child's plan of care? A. Offer mouth care before meals. B. Assess the temperature every 2 hours. C. Monitor intake and output. D. Administer an antiemetic as prescribed.
B. Assess the temperature every 2 hours.
A 6-year-old is dealing with the death of a sibling. Which action should the nurse suggest to the family to best support the child with the grieving process? A. Having the child stay with a family friend instead of attending the funeral B. Assisting the child in drawing a picture to be placed in the sibling's casket C. Having the sibling stand in the receiving line with the parents at the funeral home D. Discouraging the child from interacting with family and friends while they express their sympathy
B. Assisting the child in drawing a picture to be placed in the sibling's casket
A nurse is providing care to a toddler with nephroblastoma and is being evaluated. Which nursing action would be most important? A. Restricting the child's visitors B. Placing a "no abdominal palpation" sign above the child's bed C. Ensuring that the child be allowed nothing by mouth D. Preparing the child for chemotherapy E. Preventing weight-bearing activities
B. Placing a "no abdominal palpation" sign above the child's bed
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. Vigorously rub the child's gums with gauze to clean them. B. Provide various soft and bland foods to minimize further irritation. C. Have the child rinse the mouth with lukewarm water three times a day. D. Give the child acidic foods (e.g., orange juice) to cleanse the mouth. E. Apply a lip balm or petroleum jelly to prevent cracking.
B. Provide various soft and bland foods to minimize further irritation. C. Have the child rinse the mouth with lukewarm water three times a day. E. Apply a lip balm or petroleum jelly to prevent cracking.
A nurse is assessing a child with persistent fever, fatigue, and joint pain for 3 days. The parent denies that anyone else in the family is or has been ill, or that the child has been exposed to illness outside the family. Based on this information, what would be an appropriate action for the nurse take next? A. Notify the health care provider. B. Document the findings as a viral infection. C. Assess the child's skin for any rashes or lesions. D. Check the child's immunization schedule.
C. Assess the child's skin for any rashes or lesions. Hallmark symptoms related to leukemia include joint pain, fever, and petechiae, so the nurse should assess the skin for the presence of petechiae.
A nurse is providing care for a preschool child hospitalized with a diagnosis of acute lymphoblastic leukemia (ALL). The child is manifesting signs of infection. The nurse has contacted the health care provider, who has entered the above orders. What is the nurse's priority in carrying out these orders? A. Administer the ampicillin. B. Administer the acetaminophen. C. Draw and send the blood cultures. D. Draw and send the complete blood count (CBC) with differential.
C. Draw and send the blood cultures
The nurse realizes that the chemotherapy agents and radiation that a child is receiving are likely to irritate the bladder. What are the best measures that the nurse can take to diminish this risk? A. Administer chemotherapy during sleep periods, including naps and overnight B. Have the child wait to void until the bladder becomes full C. Keep intravenous (IV) fluids running to maintain excellent hydration and frequent voids D. Promote drinking of cranberry juice, making it an attractive oral fluid option
C. Keep intravenous (IV) fluids running to maintain excellent hydration and frequent voids
