Chapter 33: Caring for the Child With Cancer Nursing School Test Banks

Chapter 33: Caring for the Child With Cancer

MULTIPLE CHOICE

1. A nursing faculty member explains to the class that which item is the most important for tumor cell growth?
A. Age of transforming cells
B. Programmed cell death
C. Proximity to a capillary
D. Rapidity of cell growth
ANS: C
All cells, including tumor cells, need a consistent supply of oxygen and nutrients, delivered via the capillaries. Neoplastic cells must be in close enough proximity to a capillary to provide these required elements. The other factors do not have such an important role, if any, in neoplastic growth.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

2. A nursing student asks the faculty member to explain an oncogene. Which response by the faculty member is the most appropriate?
A. A cell that changes into a malignancy after environmental stress
B. Any gene found inside a solid tumor that can be removed for biopsy
C. A gene in a virus that encourages malignant transformation in cells
D. An inherited gene that is programmed to become a malignant cell
ANS: C
An oncogene is a gene found inside a virus that has the ability to encourage a normal cell to become malignant.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

3. A nurse is reviewing a patients chart and notes that the patient has a cancerous tumor that has invaded other organs. Based on this information, at which stage is this patients cancer classified?
A. Stage O
B. Stage I
C. Stage III
D. Stage IV
ANS: D
A stage IV cancer is one that has invaded other organs. Stage 0 is early cancer, present only in the cells in which it began. Stages I-III are more extensive, with larger tumors and spread to nearby lymph nodes or adjacent organs.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Easy

PTS: 1

4. A nurse hears that a new admission to the hospital was recently diagnosed with the most common kind of childhood cancer. Which collaborative care does the nurse prepare to provide to this patient?
A. Antibiotic administration
B. Bone marrow transplant
C. Chemotherapy
D. Liver transplant
ANS: C
The most common type of childhood cancer is acute lymphocytic leukemia (ALL). First-line treatment for ALL is inducing remission with chemotherapy. Antibiotics are not used unless the child has an infection. Bone marrow transplant may be considered later in the childs course of care. A liver transplant would not be a treatment for ALL.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate

PTS: 1

5. A parent brings a child to the clinic and reports that the child is reluctant to walk and has a new limp. The parent also reports that the child seems lethargic and tired all the time. The nurse notes that the child appears pale. Which other finding would warrant immediate notification of the health-care provider?
A. Difficulty staying asleep at night
B. Left-sided abdominal enlargement
C. Polyphagia and polydipsia
D. Swelling of the legs and feet
ANS: B
This child has some manifestations of acute lymphocytic leukemia (ALL). Left-sided abdominal enlargement could be indicative of splenomegaly, which is another manifestation of this disease. The nurse should report these findings immediately. Difficulty staying asleep at night is vague and could be related to a number of causes, both physical and behavioral. Polydipsia and polyphagia are two of the three classic signs of diabetes. Swelling of the legs and feet is not a manifestation of ALL.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

6. A nurse is caring for a child who is scheduled to have intrathecal chemotherapy today. Which action by the nurse is most important when providing care to this patient and family?
A. Educating family on side effects of chemotherapy
B. Ensuring a signed consent is on the chart
C. Providing distraction techniques during the process
D. Reassuring the child the parents will be present
ANS: B
Intrathecal chemotherapy (introducing chemotherapy into the subarachnoid space of the spinal cord) is an invasive procedure and requires a signed consent. Although all actions are important for this child, the priority is ensuring the consent is executed appropriately and on the chart.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Management of Care
Integrated Process: Communication and Documentation
Difficulty: Moderate

PTS: 1

7. A child is admitted and is scheduled to receive intravenous asparginase (Elspar). Which action by the nurse is most important when administering this medication?
A. Arranging an outpatient hearing test
B. Having emergency drugs on hand
C. Monitoring the childs intake and output
D. Providing anti-emetic drugs as needed
ANS: B
Anaphylaxis is a possible side effect of this drug. Emergency medications should be readily available. Ototoxicity can be caused by carboplatin (Paraplatin). Monitoring intake and output is important for any child on IV therapy. Anti-emetic drugs are important for any child receiving chemotherapy.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate

PTS: 1

8. A neutropenic child is admitted to the hospital and placed in protective isolation. Which instruction does the nurse give the family to help maintain a safe environment for the child?
A. Do not let the child have chewing gum
B. Flowers, plants, and produce are not allowed
C. The child can only have one visitor at a time
D. Toys and items from home cannot be brought in
ANS: B
The neutropenic child should not have fresh flowers, plants, fruits, or vegetables because they can harbor infectious microorganisms. The other instructions are not needed.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Safety and Infection Control
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

9. A 7-year-old child presents to the emergency department, where the parent reports a 3-week history of pale skin, extreme fatigue, and dizziness. Which laboratory value would the nurse correlate with the patients current condition?
A. Hematocrit: 33%
B. Hemoglobin: 13.2 g/dL
C. Red blood cell count: 2.8/mm3
D. White blood cell count: 12.3/mm3
ANS: C
For a child of this age, a normal RBC count is 45.2/mm3. Low RBCs can lead to pallor, fatigue, headaches, and dizziness, as tissues are not being oxygenated. The other laboratory values are normal.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Reduction of Risk Potential
Integrated Process: Nursing Process: Assessment
Difficulty: Difficult

PTS: 1

10. A child has been diagnosed with chronic myelogenous leukemia (CML). Which statement by the nurse to the parents is most appropriate?
A. Radiation therapy is the standard treatment.
B. The prognosis for this disease is extremely poor.
C. There are lots of good medications for nausea.
D. We need to test siblings for a bone marrow match.
ANS: D
The preferred treatment for CML is a bone marrow or stem cell transplant from a matching sibling, which can be curative in up to 80% of patients. Radiation therapy is not used. Although there are many good medications for nausea, this statement is not the best choice, because it is not specific to this childs condition.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Communication and Documentation
Difficulty: Moderate

PTS: 1

11. A nurse is caring for a child who has acute lymphocytic leukemia and has been treated with doxorubicin (Adriamycin). Which assessment finding would the nurse report immediately?
A. Loss of appetite
B. Low WBC count
C. Peripheral edema
D. Temperature of 100.6F (38.1C), once
ANS: C
Doxorubicin and other anthracycline drugs are known to cause heart damage. Peripheral edema may signal heart failure and should be reported right away. Loss of appetite and low WBC count are common findings for a child on chemotherapy. A single temperature of 100.6F does not need to be reported.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Reduction of Risk Potential
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

12. An 8-year-old child has been diagnosed with a brain tumor. Based on knowledge of childhood cancers, which intervention does the nurse plan to implement when the child is admitted to the hospital?
A. Aspiration precautions
B. Protective isolation
C. Safety precautions
D. Seizure precautions
ANS: C
Brain tumors in children 1 to 10 years of age are usually infratentorial and involve the brainstem and cerebellum. Manifestations of brainstem tumors result from involvement of the cranial nerves and include hemiparesis, spastic gait, and frequent stumbling and falling. The nurse implements safety precautions for this child. The other precautions may or may not be needed depending on the childs specific condition, treatment, and side effects of treatment.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Safety and Infection Control
Integrated Process: Nursing Process: Implementation
Difficulty: Difficult

PTS: 1

13. A child is 2 hours postoperative after a resection of a brain tumor. Which assessment by the nurse takes priority?
A. Blood pressure
B. Intake and output
C. Neurological exam
D. Temperature
ANS: C
All actions are appropriate for a child postoperatively. However, the answer that is most specific to this childs procedure is the neurological exam.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Management of Care
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

14. A 4-year-old child is several days postoperative after a resection of a brain tumor. The nurse finds the child irritable and lethargic, and notes that she has vomited. Which medication does the nurse anticipate administering?
A. Dexamethasone (Decadron)
B. Fosphenytoin (Cerebyx)
C. Odansetron (Zofran)
D. Phenytoin (Dilantin)
ANS: A
This child has manifestations of increased intracranial pressure, a possible outcome after brain surgery. The nurse prepares to administer a corticosteroid to decrease the edema. Fosphenytoin and phenytoin are for seizures. Odansetron is for nausea.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate

PTS: 1

15. A clinic nurse notes that a child brought in for a physical has swelling and bruising around the eyes. The patient denies any trauma and the parent reports no environmental allergies. Which assessment is most important?
A. Auscultate lungs bilaterally.
B. Inspect skin on the back.
C. Palpate abdomen and neck.
D. Percuss abdomen and flank.
ANS: C
Swelling and bruising around the face and eyes is often seen in children with neuroblastoma. Most commonly the tumor can be found by palpation of the abdomen or neck, where the tumor will present as a hard, painless mass that crosses the midline.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

16. A nurse notes in a patients medical record high levels of vanillymandelic acid (VMA). Based on this information, which condition does the nurse prepare to educate the patient and family about?
A. Ewings sarcoma
B. Hodgkins lymphoma
C. Neuroblastoma
D. Wilms tumor
ANS: C
VMA and homovanillic acid (HVA) are tests used to measure the level of catecholamine metabolites in the urine. Neuroblastomas typically secrete catecholamines, so high levels of either substance are indicative of neuroblastoma.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Reduction of Risk Potential
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

17. A nursing student is caring for a child diagnosed with Wilms tumor. Which action by the student causes the faculty member to intervene?
A. Assesses urinary output per protocol
B. Involves the parents in the childs care
C. Palpates the abdomen in all four quadrants
D. Provides frequent nutritious snacks
ANS: C
Wilms tumor is a solid, encapsulated mass that can rupture with palpation. Once the child is diagnosed with this cancer, palpation of the childs abdomen is prohibited. The other actions are appropriate.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Communication and Documentation
Difficulty: Moderate

PTS: 1

18. A nurse sees the term proptosis in a childs medical record. Which physical assessment does the nurse plan to incorporate into the childs exam based on this finding?
A. Balance testing
B. Hearing screen
C. Visual acuity
D. Strength testing
ANS: C
Proptosis is a downward displacement of the eyeball that can affect visual acuity and is frequently seen in children with rhabdomyosarcoma. The other assessments are not related.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

19. A nurse is looking at photographs of a friends infant. The nurse notes a whitish glow in the childs eyes, and the friend asks why the babys eyes look so odd. Which response by the nurse is the most appropriate?
A. If his eyes look like this by 6 months, he needs to see a doctor.
B. Take him to the doctor to see whats wrong with his eyes.
C. This is called leukocoria and may signify retinoblastoma.
D. Your baby may have a brain tumor; take him to the hospital.
ANS: C
Leukocoria (also known as the cats-eye reflex) is a whitish glow in the pupil, often noticed on photographs, and is seen in children with retinoblastoma. The child needs to be seen by his health-care provider. The mother should not wait 6 months. Advising the mother to find out whats wrong with his eyes is not as accurate as explaining the manifestation. This sign is not seen in brain tumors.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Communication and Documentation
Difficulty: Moderate

PTS: 1

20. A child is being discharged after surgical resection of a retinoblastoma with enucleation. Which discharge instruction is most important based on the diagnosis?
A. Encouraging healthy eating
B. Irrigation of the surgical site
C. Monitoring the childs temperature
D. Pain assessment and control
ANS: B
After enucleation (removal of the eye), the eye socket must be irrigated and a thin layer of antibiotic ointment applied. The other options are valid for all postoperative pediatric patients.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

21. A child has been cured of a retinoblastoma. When the parents ask how long monitoring for bone-related complications of radiation therapy should continue, which is the most appropriate response by the nurse?
A. After 5 years, you can stop worrying about this.
B. Cancers of the bone can occur up to 15 years later.
C. Probably all complications will occur within 3 years.
D. Radiation complications do not occur in bones.
ANS: B
Osteosarcoma can occur as a consequence of radiation therapy up to 15 years later.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Communication and Documentation
Difficulty: Easy

PTS: 1

22. A parent brings a 10-year-old child to the clinic, reporting that the child fell while playing and now has a limp several days later. In completing a history, which other finding would the nurse correlate more with bone cancer than a minor trauma?
A. Decreased appetite for the last month
B. Fatigues easily when playing outdoors
C. Limping several weeks prior to the fall
D. Often has unexplained extremity bruises
ANS: C
Pain and swelling are the most common manifestations of osteosarcoma. Often the child has a limp. The child also may have a dull pain at the tumor site, and if it is on a leg (weight-bearing), it could easily cause a limp that has lasted for several weeks before really being noticed. The other manifestations are vague and could be related to other problems.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Easy

PTS: 1

23. A child is in the hospital receiving chemotherapy for Hodgkins lymphoma. What action by a new nurse causes the precepting nurse to intervene?
A. Assesses the need for anti-emetics prior to starting chemotherapy
B. Checks the IV for blood return before giving the chemotherapy
C. Double wraps the chemotherapy bags and places in the trash can
D. Performs hand hygiene prior to and after caring for the patient
ANS: C
Chemotherapeutic agents are considered hazardous waste and must be disposed of in specific containers, not the trash can. The other actions are appropriate.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Safety and Infection Control
Integrated Process: Communication and Documentation
Difficulty: Easy

PTS: 1

24. A parent confides to the nurse that a friend, who is 32, has been diagnosed with Hodgkins disease. The parent says I thought only children get that! What response by the nurse is the most appropriate?
A. No, there are both young adult and older adult forms.
B. Usually people over the age of 50 do not get this.
C. Yes, only children under the age of 10 are affected.
D. You are right; your friend must have misspoken.
ANS: A
Three groups are affected by Hodgkins disease: children younger than 14, young adults 1534 years of age, and older adults 5574 years of age. The parents friend could certainly be correct about the diagnosis.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Communication and Documentation
Difficulty: Easy

PTS: 1

25. A nurse is caring for four patients who have Hodgkins lymphoma. Which child should the nurse see first?
A. Anorexia for a week
B. Enlarged cervical lymph nodes
C. Fever of 102.1F (38.9C)
D. Mediastinal mass
ANS: C
All options are possible manifestations of Hodgkins lymphoma. However, the child with a fever may have another cause for the temperature, including infection, that needs to be ruled out. This is especially true of a child receiving chemotherapy, a standard treatment for this disorder.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Management of Care
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

26. A child has liver cancer. The most recent results for the alpha-fetoprotein level show it has been reduced by 50%. Which statement by the nurse to the parents and child is most appropriate at this time?
A. Once the level gets to normal, we can resect the tumor.
B. This shows the cancer is responding to therapy.
C. Unfortunately, the chemotherapy is not working.
D. Your child will need a liver transplant soon.
ANS: B
Alpha-fetoprotein (AFP) is a protein produced by both hepatoblastomas and hepatocellular carcinomas. Falling levels of AFP indicate that treatment is working. The other responses are not correct.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Reduction of Risk Potential
Integrated Process: Communication and Documentation
Difficulty: Moderate

PTS: 1

27. The parents of a child with cancer ask the nurse why the child is losing weight even though he is eating what he normally does. Which response by the nurse is the most appropriate?
A. Cancer consumes body tissues, causing weight loss.
B. He may be going through a growth spurt right now.
C. How do you know he is eating like he normally does?
D. When you are sick, you need more nutrition than usual.
ANS: D
The demands of illness lead to increased nutritional needs. A child with cancer needs increased nutrition. Cancer does not consume body tissues. The child may be going through a growth spurt, but this is not always the case and is not the best answer. Asking the parents how they know the childs eating habits have changed may put them on the defensive.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Basic Care and Comfort
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

28. A nurse works on the pediatric oncology floor. After receiving the handoff report, which child does the nurse assess first?
A. Child on protective isolation
B. 4 hours postbone marrow biopsy
C. Not eating an hour after chemotherapy
D. Temperature of 101.5F (38.5C)
ANS: D
This fever indicates a probable infection. The nurse will see this child first and provide report to the physician, if this has not already been done. This child is the sickest and should be seen first; one might be tempted to see the child in protective isolation first to avoid cross-contamination, but by following isolation precautions, this risk is minimized. Not eating after chemotherapy is not cause for concern, and the child 4 hours postbone marrow biopsy should be stable.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Management of Care
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

29. A child has cancer, is unresponsive, and is doing poorly. Which action by the nursing student causes the faculty to intervene?
A. Allows the parents to hold the child
B. Places the child on NPO status
C. Takes the childs rectal temperature
D. Turns the child even if she moans
ANS: C
The nurse avoids the rectal route for anything: temperatures, suppositories, and enemas are not allowed, as the rectal mucosa is fragile and prone to injury, which can lead to infection. The other actions are appropriate.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Management of Care
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate

PTS: 1

30. A child needs surgery to resect a tumor, but is scheduled for several weeks of radiation therapy first. The parents are frustrated and want to know why the surgery that can cure the cancer is being delayed. Which response by the nurse is the most appropriate?
A. Children who have radiation first generally do better than others.
B. If the radiation destroys the tumor, surgery will not be needed.
C. Radiation will shrink the tumor, making it easier to get all of it out.
D. The surgeons must be worried that they cannot get the whole tumor.
ANS: C
Often radiation or chemotherapy is used prior to surgical resection to shrink the size of the tumor, maximizing the chances of complete removal. The other responses are not accurate.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

31. A student nurse wants to provide nonpharmacological pain management interventions to a hospitalized child with cancer. Which action by the student causes the faculty member to intervene?
A. Applying a moist heat pack
B. Giving the child a massage
C. Reading the child a story
D. Using candles for aromatherapy
ANS: D
Actions that have been reported by children to be effective pain control strategies are moist heat, massage, adequate rest and sleep, distraction (reading a story), and providing opportunities for social support. Open flames are prohibited in hospitals due to the risk of fire and explosion.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Basic Care and Comfort
Integrated Process: Nursing Process: Intervention
Difficulty: Moderate

PTS: 1

32. A nurse assesses a toddler using the FLACC score. The child is kicking and crying steadily. The mother is upset, as she is unable to console the child. Which action by the nurse is most appropriate?
A. Administer acetaminophen (Tylenol).
B. Give a dose of morphine (Duramorph).
C. Play soothing, quiet music.
D. Prepare a dose of propofol (Diprovan).
ANS: B
This child exhibits several behaviors seen in the severe pain category according to the FLACC score. The best medication for this level of pain is an opioid analgesic, such as morphine. Tylenol is used for mild to moderate pain. Nonpharmacological measures can be used as an adjunct, but it will not relieve this degree of pain alone. Propofol is usually used for procedures.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Nursing Process: Implementation
Difficulty: Difficult

PTS: 1

33. The nurse is completing an admission assessment on a 3-year-old child. The childs Humpty Dumpty score is 15. Which action by the nurse is the most appropriate?
A. Allow the child access to the play room.
B. Classify the child as at high risk for falls.
C. Place the child on seizure precautions.
D. Put the child in isolation precautions.
ANS: B
A Humpty Dumpty score of 12 or above indicates a high risk for falls. The child has been classified as at high risk for falls, and nursing care should be implemented to prevent them. Access to the play room can be accomplished with almost any child. Seizures and isolation actions are not related.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Safety and Infection Control
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate

PTS: 1

34. A nurse caring for a child receiving chemotherapy notes that the childs urine specific gravity is 1.010. Which action by the nurse is the most appropriate?
A. Document the findings in the childs chart.
B. Increase the rate of the IV fluids per protocol.
C. Notify the provider about the laboratory results.
D. Prepare to administer an alkalizing agent.
ANS: A
Children on chemotherapy should remain well hydrated to ensure the medications and any toxic by-products are flushed out. The urine specific gravity should remain at 1.012 or below. The nurse needs to take no further action after documenting the findings. The IV rate should be increased if the specific gravity is above that level. The provider does not need to be notified specifically about this normal finding. An alkalizing agent is not needed.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Reduction of Risk Potential
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate

PTS: 1

35. Prior to administering IV chemotherapy, which action by the nurse is most important?
A. Ensure the IV has a good blood return.
B. Provide diversionary activities.
C. Take and record a set of vital signs.
D. Weigh the child.
ANS: A
To prevent extravasation of IV chemotherapy it is important to make sure the line flushes easily and has a good blood return. This is a critical action to maintain patient safety. The other actions may also be utilized, but would not take priority over ensuring patient safety.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Safety and Infection Control
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate

PTS: 1

36. A child is receiving chemotherapy. The nurse assesses the childs oral cavity and notes the following: raspy voice, thick saliva, and debris on the teeth. Which action by the nurse is the most appropriate?
A. Have the child use commercial mouthwash.
B. Hold the next dose of chemotherapy.
C. Increase the frequency of oral care.
D. Place the child on NPO status.
ANS: C
Mucositis is a diffuse inflammation of the mouth and oral mucous membranes, and is common during chemotherapy. The nurse should increase the frequency of oral care in the child who is manifesting signs of this problem. Commercial mouthwash contains alcohol, which would burn the tissues. The chemotherapy would not be interrupted. The child should be encouraged to eat and drink as tolerated.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Basic Care and Comfort
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate

PTS: 1

37. A child has the following laboratory values: WBC, 7.2 mm3; bands, 4%; and neutrophils, 60%. Based on these values, which action by the nurse is the most appropriate?
A. Continue monitoring the child for infection.
B. Place the child on protective isolation.
C. Obtain two sets of blood cultures.
D. Restrict visitors to the child.
ANS: A
This childs absolute neutrophil count is 4,608; therefore, the child is not neutropenic. The nurse should continue to monitor. The other actions are not necessary.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Reduction of Risk Potential
Integrated Process: Nursing Process: Implementation
Difficulty: Difficult

PTS: 1

38. A child has nausea after chemotherapy despite anti-emetics. However, the child complains that my tummy is growling. Which other action should the nurse take to promote comfort for this child?
A. Avoid hard, difficult-to-chew foods.
B. Encourage a high fluid intake with meals.
C. Offer the child hard candy to suck on.
D. Provide bland items, such as plain mashed potatoes.
ANS: D
Several actions can help the child with nausea: offering plain, bland foods; avoiding spicy, heavy, or fatty foods; decreasing the odor associated with foods if that bothers the child; and having the child take food separately from liquids. Liquid together with food can make the child feel full, inducing nausea. The other options are good choices for other nutritional problems.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Basic Care and Comfort
Integrated Process: Nursing Process: Implementation
Difficulty: Easy

PTS: 1

39. A nurse works on a pediatric oncology unit. After receiving report, which child should the nurse assess first?
A. Having infusion of D5 NS and sodium bicarbonate
B. On high-dose methotrexate (Rheumatrex), urine pH of 7.8
C. Receiving cyclophosphamide (Cytoxan), urine specific gravity of 1.008
D. 2 days posttumor resection, complaining of pain
ANS: B
Patients on high-dose methotrexate need their urine pH to be higher than 7.0. This child needs the nurses attention first. An IV with NaHCO3 is common prior to receiving methotrexate. A urine specific gravity of 1.010 is required for children on chemotherapy. Pain would be an expected finding 2 days postoperatively, and should be treated, but not before the nurse assesses the other child.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Management of Care
Integrated Process: Nursing Process: Assessment
Difficulty: Difficult

PTS: 1

40. A nurse is preparing to administer chemotherapy to a child who has an Infuse-a-Port. Which action by the nurse is the most appropriate?
A. Flush the catheter with normal saline and heparin.
B. Obtain a Huber needle prior to administration.
C. Unclamp the catheter prior to flushing the line.
D. Wrap the catheter in gauze so it doesnt pull out.
ANS: B
A centrally implanted port, such as an Infuse-a-Port, must be accessed with a Huber needle. Prior to administering medication is not the time to flush with heparin. The port is entirely indwelling, so there is no catheter to unclamp, nor will the device pull out.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Safe and Effective Care Environment: Safety and Infection Control
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate

PTS: 1

MULTIPLE RESPONSE

1. The student nurse studying childhood cancers understands that neoplasms are caused by which factors? (Select all that apply.)
A. Chromosomal/genetic abnormalities
B. External stimuli or environment
C. Maternal nutrition during gestation
D. Substance abuse during pregnancy
E. Viruses that alter the immune system
ANS: A, B, E
Neoplasms are caused by one or a combination of the following: chromosomal or genetic abnormalities, external stimuli or the environment, and/or viruses that alter the immune system. Nutritional deficits and substance abuse by the mother can certainly lead to developmental and other health problems, but do not lead to childhood cancers.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

2. The nurse working with pediatric oncology patients educates the patients and families regarding best long-term follow-up practices. Which recommendations does this include? (Select all that apply.)
A. Continued care by an interdisciplinary team
B. Height measurements until puberty is reached
C. Genetic testing prior to having children
D. Risk-based follow-up appointments
E. Thyroid screening for 5 years after remission
ANS: A, D
Best-practice recommendations for follow-up include risk-based referrals and continued involvement of an interdisciplinary team of specialists. Height measurements are important for children until their adult height is achieved. Genetic testing is only recommended for certain types of cancer. Thyroid screening is important throughout the lifetime of survivors who were treated with radiotherapy to the neck, spine, or brain.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

3. The nurse is teaching a community group about early warning signs of cancer. Which signs does the nurse include? (Select all that apply.)
A. A sore that does not heal
B. Change in bowel or bladder habits
C. Difficulty swallowing or indigestion
D. Nagging feeling that something is wrong
E. Unusual bleeding or discharge
ANS: A, B, C, E
The American Cancer Society uses the acronym CAUTION to describe common warning signs of cancer: change in bowel or bladder habits; a sore that does not heal; unusual bleeding or discharge; thickening or lump in the breast, testicles, or elsewhere; indigestion or trouble swallowing; obvious change in the size, color shape, or thickness of a wart, mole, or mouth sore; and nagging cough or hoarseness.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

4. A student is learning about the process of hematopoiesis and how it is affected by leukemia. Which information does the student discover? (Select all that apply.)
A. Blast cells multiply faster than mature cells.
B. Leukemia disrupts normal hematopoiesis.
C. Lymphoid cells differentiate into B and T cells.
D. Myeloid cells crowd out normal cells in bone marrow.
E. Pancytopenia occurs from proliferation of mast cells.
ANS: A, B, C
Blast, or immature, cells have an increased rate of proliferation and multiply at the expense of normal cells. Leukemia does disrupt normal hematopoiesis (production and development of blood cells). Lymphoid cells differentiate into B and T cells. Myeloid cells differentiate into red blood cells, monocytes, granulocytes, and platelets; they do not reproduce and crowd out normal cells in the marrow. Pancytopenia occurs when large numbers of blast cells reproduce and crowd out normal marrow components.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

5. A nurse is caring for several patients with acute lymphocytic leukemia (ALL). Which children does the nurse understand have the best prognosis?
A. Infant
B. < 10 years of age
C. > 25% abnormal cells in bone marrow aspirate
D. White count 4,200/mm3
E. White count 25,000/mm3
ANS: B, D
The best prognosis for ALL occurs in children 2 to 9 years of age and in children whose initial white blood cell count is < 5,000/mm3. Children 10 and older and whose initial white blood cell counts are ?= 50,000/mm3 have worse prognoses. Infants have a very poor prognosis.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

6. The nurse is explaining types of solid tumors to a group of students. Which information does the nurse include? (Select all that apply.)
A. A sarcoma is found in bone or muscle.
B. Carcinoma means any cancerous tumor.
C. Epithelial cells give rise to carcinomas.
D. Lymphoma might originate in the thymus.
E. Pediatric and adult solid tumors are similar.
ANS: A, C, D
Pediatric and adult solid tumors are very different. A sarcoma arises from connective or supporting tissues, such as bones or muscle. A carcinoma is cancer arising from glandular and/or epithelial cells. Lymphomas originate in lymphoid organs, such as the lymph nodes, spleen, and thymus.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

7. A child is being admitted with an infratentorial brain tumor. Which anatomical regions of the brain does the nurse know this tumor might include? (Select all that apply.)
A. Brainstem
B. Cerebellum
C. Cerebrum
D. Frontal lobe
E. Parietal lobe
ANS: A, B
Brain tumors in children are classified as either supratentorial or infratentorial. Infratentorial tumors are located in the posterior third of the brain, below the tentorium, and involve the brainstem and cerebellum. The cerebrum, frontal, and parietal lobes are located in the supratentorial section of the brain, which is the anterior two-thirds of the brain structure.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Difficult

PTS: 1

8. A child has been admitted with a paraspinal Ewings sarcoma. The nursing instructor questions the student about assessing for signs of spinal cord compression. Which manifestations does this include? (Select all that apply.)
A. Burning pain down the legs
B. Difficulty with swallowing
C. Foot drop, causing a limp
D. Respiratory depression
E. Weakness in the hands
ANS: A, C, E
Common manifestations of spinal cord compression include burning pain, often down the legs; foot drop causing difficulty with ambulation; and weakness in the hands. Other manifestations include numbness, cramping, and loss of sensation in the feet, and sexual dysfunction in the older patient. Swallowing problems and respiratory depression are not related.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

9. The nurse is teaching parents about the importance of good nutrition for their child who has cancer. Which components does the nurse include as important for this childs diet? (Select all that apply.)
A. High calories
B. High carbohydrates
C. High vitamins
D. Low minerals
E. Low protein
ANS: A, C
The child with cancer needs optimal nutrition, including a diet high in calories, fatty acids, vitamins, protein, and minerals.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Difficulty: Easy

PTS: 1

10. A nurse is explaining radiation side effects to the parents of a child for whom it has been ordered. Which side effects does the nurse include in the explanation? (Select all that apply.)
A. Hair loss
B. Leukocytosis
C. Nausea
D. Polycythemia
E. Skin desquamation
ANS: A, C, E
Common side effects of radiation include nausea, alopecia (hair loss), fatigue and malaise, low WBC, skin desquamation, and mucous membrane inflammation and irritation. Leukocytosis (high WBC count) and polycythemia (increased RBC count) are not seen.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Reduction of Risk Potential
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

11. A student nurse is preparing to administer odansetron (Zofran) to a child receiving chemotherapy. The child weighs 44 lb (20 kg). Which actions by the student nurse require intervention by the faculty? (Select all that apply.)
A. Assesses the childs pain with a pediatric scale
B. Discusses side effects with the parents/child
C. Draws up 300 mg for IV administration
D. Prepares to administer 3 mg IV push
E. Withdraws a 200-mg suppository for use
ANS: A, C, E
Odansetron is an anti-emetic (not a pain medication) and can be given IV at 0.15 mg/kg, making the correct dose 3 mg. The faculty member should intervene if the student assesses pain, not nausea; draws up 300 mg; or tries to obtain a suppository for the child. Odansetron can also be given PO. Discussing side effects is a responsibility when giving medications.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Nursing Process: Implementation
Difficulty: Moderate

PTS: 1

12. The staff nurse is educating nursing students on the long-term effects of childhood chemotherapy. Which problems does the nurse include in the educational session? (Select all that apply.)
A. Cardiac dysfunction
B. Hearing loss
C. Increased risk of multiple-gestation pregnancies
D. Learning disabilities
E. Peripheral neuropathy
ANS: A, B, D, E
The list of long-term effects of chemotherapy is lengthy and includes cardiac dysfunction, hearing loss, learning disabilities, and peripheral neuropathy, among others. Sterility, not an increased risk for multiple-gestation pregnancies, is also an effect.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

13. A child is getting induction therapy for Burkitt lymphoma. The nurse finds the child lethargic and complaining of side and back pain. The childs morning laboratory results indicate a serum calcium level of 7.2 mg/dL. What actions by the nurse are the most appropriate at this time? (Select all that apply.)
A. Administer a dose of pain medication.
B. Assess Chvostek and Trousseau signs.
C. Call the rapid response team.
D. Encourage an increased oral intake.
E. Prepare to administer allopurinol (Aloprim).
ANS: A, B, E
This child is manifesting signs of tumor lysis syndrome. The child is at risk due to the rapid destruction of cancer cells (induction therapy) and from the childs type of cancer (Burkitt lymphoma). Lethargy, flank pain, and hypocalcemia are common findings in this condition. The nurse should administer pain medication, assess for physical manifestations of hypocalcemia (Chvostek and Trousseau signs), and prepare to administer allopurinol. Adequate hydration is important as well, but because the child is lethargic, IV fluids should be given, not oral fluids. The rapid response team is not needed at this point.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Implementation
Difficulty: Difficult

PTS: 1

14. A nurse has a RN preceptor student working on the pediatric oncology unit. When teaching the student about oncological crises, what disorders does the nurse include? (Select all that apply.)
A. Inferior vena cava infarction
B. Neurogenic shock
C. Perirectal abscess
D. Pleural effusion
E. Superior vena cava syndrome
ANS: B, C, D, E
There are many oncologic emergencies, including neurogenic shock (and other types of shock), perirectal abscess, pleural effusion, and superior vena cava syndrome. Inferior vena cava infarction is not on the list of emergent conditions.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Learning
Difficulty: Moderate

PTS: 1

15. A pediatric patient is receiving asparaginase (Elspar). What manifestations would lead the nurse to determine that the child is having a possible side effect from this drug? (Select all that apply.)
A. Blistering at infusion site
B. Increased PT and INR
C. Potassium of 2.7 mEq/L
D. Seizures
E. Shortness of breath
ANS: B, D
Some common side effects of Elspar include seizures, hyperglycemia, nausea/vomiting, rashes, coagulation abnormalities, hepatotoxicity, pancreatitis, and anaphylaxis. Blistering is common with daunorubicin (Daunomycin). Hypokalemia is seen with carboplatin (Paraplatin). Shortness of breath could be seen with bleomycin (Blenoxane), which causes pulmonary fibrosis and pneumonitis.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1

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