Pediatric Cancer NCLEX Questions

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15 terms amazingnur123 Preview Leukemia NCLEX questions 32 terms ohheyitskarlaPreview Pediatr 21 terms che "The mother of a child diagnosed with a potentially life- threatening form of cancer says to the nurse, ""I don't understand how this could happen to us. We have been so careful to make sure our child is healthy."" Which response by the nurse is most appropriate?"A. ""This must be a difficult time for you and your family.Would you like to talk about how you are feeling?""

• ""Why do you say that? Do you think that you could

have prevented this?""

• ""You shouldn't feel that you could have prevented the

cancer. It is not your fault.""

• ""Many children are diagnosed with cancer. It is not

always life-threatening."""

"Correct Answer: A

Parents of children diagnosed with cancer require major emotional support, and should be allowed to express their feelings. Prevention and blaming oneself is not supportive, nor is telling the parents that there are many other children with cancer." "A preschool-age child undergoing chemotherapy experiences nausea and vomiting. Which of the following would be the best intervention to include in the child's plan of care?"a. Administer tube feedings.

• Offer small, frequent meals.
• Offer fluids only between meals.
• Allow the child to choose what to eat for meals."

"Correct answer: D

While all options can be done to encourage nutrition, allowing the preschooler

choices meets two issues: nutrition and developmental tasks."

A 12 year old boy seen in the clinic, and a diagnosis of Hodgkin's disease is suspected . Which diagnostic test results confirm the diagnosis of Hodgkin's disease?

• . Elevated vanillylmandelic acid urinary level.
• The presence of blast cells in the bone marrow
• The presence of Epsetin-Barr virus in the blood.
• The presence of Reed-Sternberg cells in the lymph

nodes Correct Answer 4 . Hodgkin's disease is a neoplasm of lymphatic tissue. The presence of gaint multinucleated cells ( Reed- Sternbergs cells) is the hallmark of this disease. The presence of blast cells in the bone marrow indicates leukemia.The Epstein-Barr virus is associated with infectious mononucleosis . Elevated levels of vanillylmandelic acid in the urine may be found in children with neroblastoma."Which nursing diagnosis is highest-priority for a child undergoing chemotherapy and experiencing nausea and vomiting?"A. Fluid and Electrolyte Imbalance

• Alterations in Nutrition
• Alterations in Skin Integrity
• Body Image Disturbances"

"Correct Answer: A

While all of the nursing diagnoses listed here are important, dehydration and fluid and electrolyte loss secondary to vomiting is the priority for this client."

"A child with cancer has the following lab result: WBC

10,000, RBC 5, and plts of 20,000. When planning this child's care, which risk should the nurse consider most significant?"A. Hemorrage

• Anemia
• Infection
• Pain"

"Correct answer: A Hemorrhage

The lab values presented all are normal except for the platelet count. Decreases in platelet counts place the child at greatest risk for hemorrhage." "Chemotherapy dosage is frequently based on total body surFace area (BSA), so it is important for the nurse to do which of the following before administering chemotherapy?"1. Measure abdominal girth

• Claculate BMI
• Ask the client about his/her height and weight
• Weigh and measure the client on the day of medication

administration" "Answer: 4 To ensure that the client receives optimal doses of chemotherapy, dosing is usually based on the total Body surface area(BSA) which requires accurate height and weight before each med administration.Simply asking the client about height/weight may lead to inaccuracies in determining BSA. Calculating BMI and measuring abdominal girth does not provide the data needed." "Which diagnostic test should be performed annually after age 50 to screen for colon cancer?"a. Abdominal computed tomography (CT)

• Abdominal X-ray
• Colonoscopy
• Fecal occult blood test"

Answer d: Surface blood vessels of polyps and cancers are fragile and often

bleed with the passage of stools, so a fecal occult blood test and CT scan can help establish tumor size and metastasis. A colonoscopy can help to locate a tumor as well as polyps, but is only recommended every 10 years."David, age 15 months, is recovering from surgery to remove Wilms' tumor. Which findings best indicates that the child is free from pain?"a. Decreased appetite

• Increased heart rate
• Decreased urine output
• Increased interest in play"

"Correct: D

Answer D. One of the most valuable clues to pain is a behavior change: A child

who's pain-free likes to play. A child in pain is less likely to consume food or fluids.An increased heart rate may indicate increased pain; decreased urine output may signify dehydration."

A nurse analyzes the lab values of a child with leukemia who is receiving chemotherapy. The nurse notices that the platelet count is 19,500 cell/mm3. Based on this lab value which intervention would the nurse document in her plan of care. " "1. Monitor closely for signs of infection.

• Temp every four hours.
• Isolation precautions
• Use a small toothbrush for mouth care"

4. **Correct... Rationale: Leukemia is a malignant increase in the number of

leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production. If the platelet count is les than 20,000 than bleeding precautions need to be taken."The parent of a child undergoing chemotherapy asks the nurse why the child must wear a mask in public places. Which of the following responses by the nurse would be most appropriate?"A) ""Chemotherapy causes dry mouth, and the mask will help contain moisture.""

• ""Chemotherapy decreases immune system function,

increasing the risk of acquiring an infection.""

• ""Chemotherapy makes the oral mucous membranes

deteriorate and makes them susceptible to infection.""

• ""Chemotherapy kills cancer cells, and your child might

spread those cells to others."""

"Correct: B

Chemotherapeutic agents decrease the immunity of the child. Proper use of the mask will decrease the chance of acquiring an infection. Cancer is not spread; a mask cannot contain moisture; and unsightly mouth sores are not a medical reason to wear a mask." A child is diagnosed with Wilms' tumor. In planning teaching interventions, what key point should the nurse emphasize to the parents?"1. Do not put pressure on the abdomen.

• Frequent visits from friends and family will improve

morale.

• Appropriate protective equipment should be worn for

contact sports.

• Encourage the child to remain active."

Correct answer: 1. Do not put pressure on the abdomen. Palpation of Wilms' tumor can cause rupture and spread of cancerous cells. Frequent visitation might allow the child to be exposed to more infections, and activity and sports are discouraged because of the risk of rupture of the encapsulated tumor."A child is diagnosed with Wilms' tumor. During

assessment, the nurse in charge expects to detect:

"a. Gross hematuria

• Dysuria
• Nausea and vomiting
• An abdominal mass"

"CORRECT: D

The most common sign of Wilms' tumor is a painless, palpable abdominal mass, sometimes accompanied by an increase in abdominal girth. Gross hematuria is uncommon, although microscopic hematuria may be present. Dysuria is not associated with Wilms' tumor. Nausea and vomiting are rare in children with Wilms' tumor." The mother of a 5-year-old child asks the nurse questions regarding the importance of vigilant use of sunscreen.Which information is most important for the nurse to convey to the mother?"a.) Appropriate use of sunscreen decreases the risk of skin cancer.b.) Repeated exposure to the sun causes premature aging of the skin.c.) A child's skin is delicate, and burns easily.d.) In addition to causing skin cancer, repeated sun exposure predisposes the child to other forms of cancer."

"Correct: A.

While all of the answer choices are correct, recommending the use of sunscreen to decrease the incidence of skin cancer (a) is the best response."

"A 15-year-old has been admitted to the hospital with the diagnosis of acute lymphocytic leukemia. Which of the following signs and symptoms require the most immediate nursing intervention?(Choices were deleted)

Correct: 2. Fever and petechiae associated with acute lymphocytic leukemia

indicate a suppression of normal white blood cells and thrombocytes by the bone marrow and put the client at risk for other infections and bleeding. The nurse should initiate infection control and safety precautions to reduce these risks.Fatigue is a common symptom of leukemia due to red blood cell suppression.Although the client should be told about the need for rest and meal planning, such teaching is not the priority intervention. Swollen glands and lethargy may be uncomfortable but they do not require immediate intervention. An enlarged liver and spleen do require safety precautions that prevent injury to the abdomen; however, these precautions are not the priority.A child with leukemia is being discharged after beginning chemotherapy. Which of the following instructions will the nurse include when teaching the parents of this child?"A. provide a diet low in protein and high in carboydrates

• avoid fresh vegetables that are not cooked or peeled
• notify the doctor if the child's temp exceeds 101

degrees F

• increase the use of humidifiers throughout the house"

Answer B - fresh vegetables harbor microorganisms, which can cause infections in immune-compromised children, fruit or vegetables should be either peeled or cooked. The physician should be notified of a temp above 100 degrees F. A diet low in protein is not indicated. Humidifiers harbor fungi in the water containers."The pediatric nurse understands that the most common

cancer found in children is:

"1. Non-hodgkin's lymphoma

• Acute lymphocytic leukemia
• Chronic lymphocytic leukemia
• Ewing's sarcoma"

"Correct: 2.

• No - this is not a common cancer in children
• YES! this is the most common form of cancer found in children is acute

lymphocytic leukemia.

• No - this is not a common cancer in children
• No - this is not a common cancer in children"

"When assessing a child with Wilm's tumor, the nurse should keep in mind that it is most important to avoid which of the following?"A. Measuring the child's chest circumference

• Palpating the child's abdomen
• Placing the child in an upright position
• Measuring the child's occipitofrontal circumference"

"Answer: B. The abdomen of the child with Wilm's tumor should not be palpated because of the danger of disseminating tumor cells. Children with Wilm's tumor should always be handled gently and carefully.Other answers. The child's head and chest measuring will not affect Wilm's tumor.Repositioning a child in the upright position may cause more pain to the child, but priority this is not worse than disseminating tumor cells." A nurse is teaching a client about the risk factors associated with colorectal cancer. The nurse determines that further teaching related to the colo-rectal cancer is necessary if the client identifies which of the following as an associated risk factor?"1. Age younger than 50 years

• History of coloractal polyps
• Family history of colorectal cancer
• Chronic inflammatory bowel disease"

"Correct: 1.

Colorectal cancer risk factors include age older than 50 years, a family history of the disease, colorectal polyps, and chronic inflammatory bowel disease."