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Wongs Nursing Care of Infants and Children 9th Edition Hockenberry Wilson Test Bank

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Wongs Nursing Care of Infants and Children 9th Edition Hockenberry Wilson Test Bank

ISBN-13: 978-0323244251

ISBN-10: 0323244254

Description

Wongs Nursing Care of Infants and Children 9th Edition Hockenberry Wilson Test Bank

ISBN-13: 978-0323244251

ISBN-10: 0323244254

 

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Below you will find some free nursing test bank questions from this test bank:

 

Hockenberry: Wong’s Nursing Care of Infants and Children, 9th Edition

 

Chapter 36: The Child with Cancer

 

Test Bank

 

MULTIPLE CHOICE

 

  1. Which of the following childhood cancers may demonstrate patterns of inheritance that suggest a familial basis?
a. Leukemia
b. Retinoblastoma
c. Rhabdomyosarcoma
d. Osteogenic sarcoma

 

 

ANS:  B

Retinoblastoma is an example of a pediatric cancer that demonstrates inheritance. The absence of the retinoblastoma gene allows for abnormal cell growth and the development of retinoblastoma. Chromosome abnormalities are present in many malignancies. They do not indicate a familial pattern of inheritance. The Philadelphia chromosome is observed in almost all individuals with chronic myelogenous leukemia. There is no evidence of a familial pattern of inheritance for rhabdomyosarcoma or osteogenic sarcoma cancers.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 1463

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Physiological Integrity: Physiologic Adaptation

 

  1. As part of the diagnostic evaluation of a child with cancer, biopsies are important for staging. Which of the following explains what staging means?
a. Extent of the disease at the time of diagnosis
b. Rate normal cells are being replaced by cancer cells
c. Biologic characteristics of the tumor and/or lymph nodes
d. Abnormal, unrestricted growth of cancer cells producing organ damage

 

 

ANS:  A

Staging is a description of the extent of the disease at the time of diagnosis. Staging criteria exist for most tumors. The stage usually relates directly to the prognosis; the higher the stage, the poorer the prognosis. The rate that normal cells are being replaced by cancer cells is not a definition of staging. Classification of the tumor refers to the biologic characteristics of the tumor and/or lymph nodes. Abnormal, unrestricted growth of cancer cells producing organ damage describes how cancer cells grow and can cause damage to an organ.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 1486           TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiological Integrity: Physiologic Adaptation

 

  1. Clinical trials developed for pediatric cancers:
a. are accessible only in major pediatric centers.
b. do not require consent for standard therapy.
c. provide the best available therapy compared with an expected improvement.
d. are standardized to provide the same treatment to all children with the disease.

 

 

ANS:  C

Most clinical trials have a control group where the patients receive the best available therapy currently known. The experimental group(s) receives treatment that is thought to be even better. The protocol outlines the therapy plan. Protocols are developed for many pediatric cancers. They can be accessed by pediatric oncologists throughout the United States. Consent is always required in treatment of children, especially for research protocols. The protocol is designed to optimize therapy for children based on disease type and stage.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 1465

TOP:   Nursing Process: Implementation

MSC:  Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. Chemotherapeutic agents are classified according to:
a. side effects.
b. effectiveness.
c. mechanism of action.
d. route of administration.

 

 

ANS:  C

Chemotherapeutic agents are classified according to mechanism of action. For example, antimetabolites resemble essential metabolic elements needed for growth, but are different enough to block further deoxyribonucleic acid (DNA) synthesis. Although the side effect profiles may be similar for drugs within a classification, they are not the basis for classification. Most chemotherapeutic regimens contain combinations of drugs. The effectiveness of any one drug is relative to the cancer type, combination therapy, and protocol for administration. The route of administration is determined by the pharmacodynamics and pharmacokinetics of each drug.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 1465

TOP:   Nursing Process: Implementation

MSC:  Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. Which of the following types of chemotherapeutic agents alters the function of cells by replacing a hydrogen atom of a molecule?
a. Plant alkaloids
b. Antimetabolites
c. Alkylating agents
d. Antitumor antibiotics

 

 

ANS:  C

Alkylating agents replace a hydrogen atom with an alkyl group. The irreversible combination of alkyl groups with nucleotide chains, particularly deoxyribonucleic acid (DNA), causes unbalanced growth of unaffected cell constituents so that the cell eventually dies. Plant alkaloids arrest the cell in metaphase by binding to proteins needed for spindle formation. Antimetabolites resemble essential metabolic elements needed for growth, but are different enough to block further DNA synthesis. Antitumor antibiotics are natural substances that interfere with cell division by reacting with DNA in such a way as to prevent further replication of DNA and transcription of ribonucleic acid (RNA).

 

DIF:    Cognitive Level: Comprehension     REF:   p. 1465

TOP:   Nursing Process: Implementation

MSC:  Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A common side effect of corticosteroid (prednisone) therapy is:
a. alopecia.
b. anorexia.
c. nausea and vomiting.
d. susceptibility to infection.

 

 

ANS:  D

Corticosteroids have immunosuppressive effects. Children who are taking prednisone are susceptible to infections. Hair loss is not a side effect of corticosteroid therapy. Children taking corticosteroids have increased appetites. Gastric irritation, not nausea and vomiting, is a potential side effect. The medicine should be given with food.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 1466

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. Which of the following chemotherapeutic agents is classified as an antitumor antibiotic?
a. Cisplatin
b. Vincristine
c. Methotrexate
d. Daunorubicin

 

 

ANS:  D

Daunorubicin is an antitumor antibiotic. Cisplatin is classified as an alkylating agent. Vincristine is a plant alkaloid. Methotrexate is an antimetabolite.

 

DIF:    Cognitive Level: Comprehension     REF:   pp. 1465, 1503

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is administering an intravenous chemotherapeutic agent to a child with leukemia. The child suddenly begins to wheeze and have severe urticaria. Which of the following is the most appropriate nursing action?
a. Recheck rate of drug infusion.
b. Stop drug infusion immediately.
c. Observe child closely for next 10 minutes.
d. Explain to child that this is an expected side effect.

 

 

ANS:  B

When an allergic reaction is suspected, the drug is immediately discontinued. Any drug in the line should be withdrawn, and a normal saline infusion begun to keep the line open. The intravenous infusion is stopped to minimize the amount of drug that infuses. The infusion rate can be confirmed at a later time. Observation of the child for 10 minutes is essential, but it is done after the infusion is stopped. These symptoms are indicative of an allergic reaction, not an expected response.

 

DIF:    Cognitive Level: Analysis                REF:   p. 1466

TOP:   Nursing Process: Implementation

MSC:  Client Needs: Physiological Integrity: Physiologic Adaptation

 

  1. Total body irradiation is indicated for which of the following reasons?
a. Palliative care
b. Lymphoma therapy
c. Definitive therapy for leukemia
d. Preparation for bone marrow transplant

 

 

ANS:  D

Total body irradiation is used as part of the destruction of the child’s immune system necessary for a bone marrow transplant. The child is at great risk for complications, since there is no supportive therapy until engraftment of the donor marrow takes place. Irradiation for palliative care is done selectively. The area that is causing pain or potential obstruction is irradiated. Lymphoma and leukemia are treated through a combination of modalities. Total body irradiation is not indicated.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 1467

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Physiological Integrity: Physiologic Adaptation

 

  1. The parents of a child with cancer tell the nurse that a bone marrow transplant (BMT) may be necessary. Which of the following should the nurse recognize as important when discussing this with the family?
a. BMT should be done at the time of diagnosis.
b. Parents and siblings of the child have a 25% chance of being a suitable donor.
c. If BMT fails, chemotherapy or radiotherapy will need to be continued.
d. Finding a suitable donor involves matching antigens from the human leukocyte antigen (HLA) system.

 

 

ANS:  D

The most successful BMTs come from suitable HLA-matched donors. The timing of a BMT depends on the disease process involved. It usually follows intensive high-dose chemotherapy and/or radiotherapy. Usually, parents only share approximately 50% of the genetic material with their children. A one-in-four chance exists that two siblings will have two identical haplotypes and will be identically matched at the HLA loci. The decision to continue chemotherapy or radiotherapy if BMT fails is not appropriate to discuss with the parents when planning the BMT. That decision will be made later.

 

DIF:    Cognitive Level: Analysis                REF:   p. 1468

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity: Reduction of Risk Potential

 

  1. An adolescent will receive a bone marrow transplant (BMT). The nurse should explain that the bone marrow will be administered by which of the following?
a. Bone grafting
b. Intravenous infusion
c. Bone marrow injection
d. Intraabdominal infusion

 

 

ANS:  B

Bone marrow from a donor is infused intravenously, and the transfused stem cells migrate to the recipient’s marrow and repopulate it.

 

DIF:    Cognitive Level: Analysis                REF:   p. 1468

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. After chemotherapy is begun for a child with acute leukemia, prophylaxis to prevent acute tumor lysis syndrome includes:
a. hydration.
b. oxygenation.
c. corticosteroids.
d. pain management.

 

 

ANS:  A

Acute tumor lysis syndrome results from the release of intracellular metabolites during the initial treatment of leukemia. Hyperuricemia, hypocalcemia, hyperphosphatemia, and hyperkalemia can result. Hydration is used to reduce the metabolic consequences of the tumor lysis. Oxygenation is not helpful in preventing the acute tumor lysis syndrome. Allopurinol, not corticosteroids, is indicated for pharmacologic management. Pain management may be indicated for supportive therapy of the child, but it does not prevent acute tumor lysis syndrome.

 

DIF:    Cognitive Level: Analysis                REF:   p. 1469

TOP:   Nursing Process: Implementation

MSC:  Client Needs: Physiological Integrity: Physiologic Adaptation

 

  1. Nursing care of the child with myelosuppression from leukemia or chemotherapeutic agents should include which of the following?
a. Restrict oral fluids.
b. Institute strict isolation.
c. Use good hand-washing technique.
d. Give immunizations appropriate for age.

 

 

ANS:  C

Good hand washing minimizes the exposure to infectious organisms and decreases the chance of infection spread. Oral fluids are encouraged if the child is able to drink. If possible, the intravenous route is not used because of the increased risk of infection from parenteral fluid administration. Strict isolation is not indicated. When the child is immunocompromised, the vaccines are not effective. If necessary, the appropriate immunoglobulin is administered.

 

DIF:    Cognitive Level: Analysis                REF:   p. 1471

TOP:   Nursing Process: Implementation

MSC:  Client Needs: Physiological Integrity: Reduction of Risk Potential

 

  1. In teaching parents how to minimize or prevent bleeding episodes when the child is myelosuppressed, the nurse includes that:
a. meticulous mouth care is essential to avoid mucositis.
b. rectal temperatures are necessary to monitor for infection.
c. intramuscular injections are preferred to intravenous.
d. platelet transfusions are given to maintain a count greater than 50,000/mm3.

 

 

ANS:  A

The decrease in blood platelets secondary to the myelosuppression of chemotherapy can cause an increase in bleeding. The child and family are taught how to perform good oral hygiene to minimize gingival bleeding and mucositis. Rectal temperatures are avoided to minimize risk of ulceration. Hygiene is also emphasized. Intramuscular injections are avoided because of the risk of bleeding into the muscle and of infection. Platelet transfusions are usually not given unless there is active bleeding and/or the platelet count is less than 10,000/mm3. The use of platelets when not necessary can contribute to antibody formation and increased destruction of platelets when transfused.

 

DIF:    Cognitive Level: Application           REF:   p. 1474           TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiological Integrity: Reduction of Risk Potential

 

  1. A school-age child with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time. Which of the following is the most appropriate nursing action to prevent or minimize these reactions with subsequent treatments?
a. Administer the chemotherapy between meals.
b. Give an antiemetic before chemotherapy begins.
c. Have the child bring favorite foods for snacks.
d. Keep the child NPO (nothing by mouth) until nausea and vomiting subside.

 

 

ANS:  B

The most beneficial regimen to minimize nausea and vomiting associated with chemotherapy is to administer a 5-hydroxytryptamine-3 receptor antagonist (such as ondansetron) before the chemotherapy is begun. The goal is to prevent anticipatory symptoms. The child will experience nausea with chemotherapy whether or not food is present in the stomach. Since some children develop aversions to foods eaten during chemotherapy, refraining from offering favorite foods is advised. Keeping the child NPO until nausea and vomiting subside will help with this episode, but the child will have the discomfort and be at risk for dehydration.

 

DIF:    Cognitive Level: Application           REF:   p. 1475

TOP:   Nursing Process: Implementation

MSC:  Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A young child with leukemia has anorexia and severe stomatitis. The nurse should suggest that the parents try which of the following?
a. Relax any eating pressures.
b. Firmly insist that child eat normally.
c. Serve foods that are either hot or cold.
d. Provide only liquids, since chewing is painful.

 

 

ANS:  A

A multifaceted approach is necessary for children with severe stomatitis and anorexia. First, the parents should relax eating pressures. The nurse should suggest that the parents try soft, bland foods; normal saline or bicarbonate mouthwashes; and local anesthetics. Insisting that the child eat normally is not suggested. For some children not eating may be a way to maintain some control. This can set the child and caregiver in opposition to each other. Hot and cold foods can be painful on ulcerated mucosal membranes. Substitution of high-calorie foods that the child likes and can eat should be used.

 

DIF:    Cognitive Level: Analysis                REF:   p. 1476

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity: Physiologic Adaptation

 

  1. The nurse is preparing a child for possible alopecia from chemotherapy. Which of the following should be included?
a. Wearing hats or scarves is preferable to a wig.
b. Expose head to sunlight to stimulate hair regrowth.
c. Hair may have a slightly different color or texture when it regrows.
d. Regrowth of hair usually begins 12 months after chemotherapy ends.

 

 

ANS:  C

Alopecia is a side effect of certain chemotherapeutic agents and cranial irradiation. When the hair regrows, it may be of different color or texture. Children should choose the head covering they prefer. A wig should be selected similar to the child’s own hairstyle and color before the hair loss. The head should be protected from sunlight to avoid sunburn. The hair usually grows back within 3 to 6 months after the cessation of treatment.

 

DIF:    Cognitive Level: Application           REF:   p. 1477

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Psychosocial Integrity

 

  1. Which of the following is the most effective pain management approach for a child who is having a bone marrow test?
a. Relaxation techniques
b. Administration of an opioid
c. EMLA cream applied over site
d. Conscious or unconscious sedation

 

 

ANS:  D

Children need explanations before each procedure that is being done to them. Effective pharmacologic and nonpharmacologic measures should be used to minimize pain associated with procedures. For bone marrow aspiration, conscious or unconscious sedation should be used. Relaxation, opioids, and EMLA can be used to augment the sedation.

 

DIF:    Cognitive Level: Application           REF:   p. 1478           TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. 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. Which of the following should the nurse recommend in terms of dental care for this child?
a. Rinsing mouth with water
b. Daily toothbrushing and flossing
c. Lemon glycerin swabs for cleansing
d. Wiping teeth with moistened gauze or Toothettes

 

 

ANS:  B

Oral care is essential for children receiving chemotherapy to prevent infections and other complications. When the child’s granulocyte count is above 500/mm3 and platelet count is above 40,000/mm3, daily brushing and flossing are recommended. Rinsing the mouth with water is not effective for oral hygiene. Lemon glycerin swabs are avoided because they have a drying effect on the mucous membranes, and the lemon may irritate eroded tissue and decay the child’s teeth. Wiping teeth with moistened gauze or Toothettes is recommended when the child’s granulocyte count is below 500/mm3 and platelet count is below 40,000/mm3.

 

DIF:    Cognitive Level: Application           REF:   p. 1479           TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiological Integrity: Reduction of Risk Potential

 

  1. Which of the following immunizations should not be given to a child receiving chemotherapy for cancer?
a. Tetanus vaccine
b. Inactivated poliovirus vaccine
c. Diphtheria, pertussis, tetanus (DPT)
d. Measles, mumps, rubella (MMR)

 

 

ANS:  D

The vaccine used for measles, mumps, and rubella is a live virus and can cause serious disease in immunocompromised children. The tetanus vaccine, inactivated poliovirus vaccine, and DPT are not live vaccines and can be given to immunosuppressed children. The immune response is likely to be suboptimum, so delaying vaccination is usually recommended.

 

DIF:    Cognitive Level: Application           REF:   p. 1479

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. Which of the following is most descriptive of the pathophysiology of leukemia?
a. Increased blood viscosity
b. Abnormal stimulation of the first stage of coagulation process
c. Unrestricted proliferation of immature white blood cells (WBCs)
d. Thrombocytopenia from an excessive destruction of platelets

 

 

ANS:  C

Leukemia is a group of malignant disorders of the bone marrow and lymphatic system. It is defined as an unrestricted proliferation of immature WBCs in the blood-forming tissues of the body. Increased blood viscosity may result secondary to the increased number of WBCs. The coagulation process is unaffected by leukemia. Thrombocytopenia may occur secondary to the overproduction of WBCs in the bone marrow.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 1481

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Physiological Integrity: Physiologic Adaptation

 

  1. A child with leukemia is receiving intrathecal chemotherapy. The purpose of this is to prevent:
a. infection.
b. brain tumor.
c. central nervous system (CNS) disease.
d. drug side effects.

 

 

ANS:  C

Children with leukemia are at risk for invasion of the CNS with leukemic cells. CNS prophylactic therapy is indicated. Intrathecal chemotherapy does not prevent infection or drug side effects. A brain tumor in a child with leukemia would be a second tumor, and additional appropriate therapy would be indicated.

 

DIF:    Cognitive Level: Application           REF:   p. 1483           TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiological Integrity: Physiologic Adaptation

 

  1. A parent tells you that 80% of children with the same type of leukemia as his son’s have a 5-year survival. Since another child on the same protocol as his son has just died, his son now has a better chance of success. The nurse’s best response is:
a. it is sad for the other family, but good news for his child.
b. each child has an 80% likelihood of 5-year survival.
c. the data suggest that 20% of the children in the clinic will die. There are still many hurdles for his son.
d. he should avoid the grieving family, since he will be benefiting from their loss.

 

 

ANS:  B

This is a common misconception for parents. The success data are based on numerous factors, including the effectiveness of the protocol and the child’s response. These are aggregate data that apply to each child and do not depend on the success or failure in other children. The failure of one child in a protocol does not improve the success rate for other children. Although his son does face more hurdles, these are aggregate data, not specific to the clinic. It may be difficult for this family to be supportive given their concerns about their child. Families usually form support groups in pediatric oncology settings, and support during bereavement is common.

 

DIF:    Cognitive Level: Application           REF:   p. 1484

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Psychosocial Integrity

 

  1. Which of the following is a common clinical manifestation of Hodgkin disease?
a. Petechiae
b. Bone and joint pain
c. Painful, enlarged lymph nodes
d. Nontender enlargement of lymph nodes

 

 

ANS:  D

Asymptomatic, enlarged, cervical or supraclavicular lymphadenopathy is the most common presentation of Hodgkin disease. Petechiae are usually associated with leukemia. Bone and joint pain are not likely in Hodgkin disease. The enlarged nodes are rarely painful.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 1485

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Physiological Integrity: Physiologic Adaptation

 

  1. The most common clinical manifestations of brain tumors in children are which of the following?
a. Headaches and vomiting
b. Blurred vision and ataxia
c. Hydrocephalus and clumsy gait
d. Fever and poor fine motor control

 

 

ANS:  A

Headaches, especially on awakening, and vomiting that is not related to feeding are the most common clinical manifestations of brain tumors in children. Diplopia (double vision), not blurred vision, can be a presenting sign of brainstem glioma. Ataxia is a clinical manifestation of brain tumors, but headaches and vomiting are the most common. Hydrocephalus can be a presenting sign in infants when the sutures have not closed. Children at this age are usually not walking steadily. Poor fine motor coordination may be a presenting sign of astrocytoma, but headaches and vomiting are the most common presenting sign of brain tumors.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 1488

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Physiological Integrity: Reduction of Risk Potential

 

  1. A 5-year-old child is being prepared for surgery to remove a brain tumor. Nursing actions should be based on which of the following?
a. Removal of tumor will stop the various symptoms.
b. Usually the postoperative dressing covers the entire scalp.
c. He is not old enough to be concerned about his head being shaved.
d. He is not old enough to understand the significance of the brain.

 

 

ANS:  B

The child should be told what he will look and feel like after surgery. This includes the anticipated size of the dressing. The nurse can demonstrate on a doll the expected size and shape of the dressing. Some of the symptoms may be alleviated by removal of the tumor, but postsurgical headaches and cerebellar symptoms such as ataxia may be aggravated. Children should be prepared for the loss of their hair, and it should be removed in a sensitive, positive manner if the child is awake. Children at this age have poorly defined body boundaries and little knowledge of internal organs. Intrusive experiences are frightening, especially those that disrupt the integrity of the skin.

 

DIF:    Cognitive Level: Application           REF:   p. 1490

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Psychosocial Integrity

 

  1. Essential postoperative nursing management of a child after removal of a brain tumor includes:
a. turning and positioning every 2 hours.
b. measuring all fluid intake and output.
c. changing the dressing when it becomes soiled.
d. using maximum lighting to ensure accurate observations.

 

 

ANS:  B

After brain surgery, cerebral edema is a risk. Careful monitoring is essential. All fluids, including intravenous antibiotics, are included in the intake. Turning and positioning depend on the surgical procedure. When large tumors are removed, the child is usually not positioned on the operative side. The dressing is not changed. It is reinforced with gauze after the amount of drainage is marked and estimated. A quiet, dimly lit environment is optimum to decrease stimulation and relieve discomfort such as headaches.

 

DIF:    Cognitive Level: Application           REF:   p. 1492           TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiological Integrity: Physiologic Adaptation

 

  1. An adolescent is scheduled for a leg amputation in 2 days for treatment of osteosarcoma. The nurse’s approach should include which of the following?
a. Answer questions with straightforward honesty.
b. Avoid discussing the seriousness of the condition.
c. Explain that, although the amputation is difficult, it will cure the cancer.
d. Help the adolescent accept the amputation as better than a long course of chemotherapy.

 

 

ANS:  A

Honesty is essential to gain the child’s cooperation and trust. The diagnosis of cancer should not be disguised with falsehoods. The adolescent should be prepared for the surgery so there is time for reflection about the diagnosis and subsequent treatment. This allows questions to be answered. To accept the need for radical surgery, the child must be aware of the lack of alternatives for treatment. Amputation is necessary, but it will not guarantee a cure. Chemotherapy is an integral part of the therapy with surgery. The child should be informed of the need for chemotherapy and its side effects before surgery.

 

DIF:    Cognitive Level: Analysis                REF:   p. 1495

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Psychosocial Integrity

 

  1. In a child suspected of having Wilms tumor an important priority is:
a. intervening to minimize bleeding.
b. monitoring temperature for infection.
c. ensuring the abdomen is protected from palpation.
d. teaching parents how to manage the parenteral nutrition.

 

 

ANS:  C

Wilms tumor, or nephroblastoma, is the most common malignant renal and intraabdominal tumor of childhood. The abdomen is protected and palpation is avoided. Careful handling and bathing are essential to prevent trauma to the tumor site. Before chemotherapy, the child is not myelosuppressed. Bleeding is not usually a risk. Infection is a concern after surgery and during chemotherapy, not before surgery. Parenteral therapy is not indicated before surgery.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 1498           TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiological Integrity: Physiologic Adaptation

 

  1. 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 of the following?
a. Brain tumor
b. Retinoblastoma
c. Neuroblastoma
d. Rhabdomyosarcoma

 

 

ANS:  B

When the nurse examines the eye, the light will reflect off of the tumor, giving the eye a whitish appearance. This is called a cat’s eye reflex. Brain tumors are not usually visible. Neuroblastoma usually arises from the adrenal medulla and sympathetic nervous system. Most common presentation sites are in the abdomen, head, neck, or pelvis. Supraorbital ecchymosis may be present with distant metastasis. Rhabdomyosarcoma is a soft tissue tumor that derives from skeletal muscle undifferentiated cells.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 1500

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Physiological Integrity: Reduction of Risk Potential

 

  1. 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?” Which of the following statements would be most appropriate for the nurse to make?
a. “You should give your child aspirin instead of acetaminophen for fever or pain.”
b. “Your child should avoid contact sports or activities that could cause bleeding.”
c. “You should feed your child bland, soft, moist diet for the next week.”
d. “Your child should avoid large groups of people for the next week.”

 

 

ANS:  B

A child with a low platelet count needs to avoid activities that could cause bleeding such as playing contact sports, climbing trees, using playground equipment, or bike riding. The child should be given acetaminophen, not aspirin, for fever or pain; the child does not need to be on a soft, bland diet or avoid large groups of people because of the low platelet count.

 

DIF:    Cognitive Level: Application           REF:   p. 1474           TOP:   Nursing Process: Planning

MSC:  Client Needs: Physiological Integrity: Physiologic Adaptation

 

MULTIPLE RESPONSE

 

  1. The nurse is precepting a new graduate nurse at an ambulatory pediatric hematology/oncology clinic. Which of the following cardinal signs of cancer in children should the nurse make the new nurse aware of? Select all that apply.
a. Sudden tendency to bruise easily
b. Transitory, generalized pain
c. Frequent headaches
d. Excessive, rapid weight gain
e. Gradual, steady fever
f. Unexplained loss of energy

 

 

ANS:  A, C, F

The cardinal signs of cancer in children include a sudden tendency to bruise easily; frequent headaches, often with vomiting; and an unexplained loss of energy. Other cardinal signs include persistent, localized pain; excessive, rapid weight loss; and a prolonged, unexplained fever.

 

DIF:    Cognitive Level: Application           REF:   p. 1464

TOP:   Integrated Process: Teaching/Learning

MSC:  Client Needs: Physiological Integrity: Physiologic Adaptation