Deck 29: Cellular Alterations

Question 1

Which of the following is the leading cause of death from disease in children 1 to 14 years of age?

A) cancer
B) heart disease
C) diabetes
D) cerebral palsy

Answer 1

cancer

Question 2

Which of the following statements comparing childhood cancer with adult cancer is true?

A) There is no difference in childhood cancer and adult cancer.
B) Childhood cancers usually arise from primitive embryonic tissue and adult malignancies are of epithelial origin.
C) Routine screens catch childhood cancers more often than adult cancers.
D) Exposure to carcinogens is related in a stronger way to childhood cancers than to adult cancers.

Answer 2

Childhood cancers usually arise from primitive embryonic tissue and adult malignancies are of epithelial origin.

Question 3

What is the cure rate for childhood cancers?

A) less than 20%
B) 40%
C) 50%
D) greater than 70%

Answer 3

greater than 70%

Question 4

Which of the following methods provides an organized, coordinated approach to cancer treatment?

A) Internet groups providing information on nontraditional treatment programs out of the country
B) survivors' group comparing information and disseminating it to others with cancer
C) the use of clinical trials and the resultant data to improve therapy and increase survival
D) specialized hospitals and cancer specialists providing training workshops

Question 5

The nurse is working with a client who has cancer that has been staged as a stage I. The nurse realizes that this cancer is best described as:

A) a cancer with disseminated metastatic disease
B) cancer with a certainty of being fatal
C) a localized disease in just one area or organ
D) the end stage of cancer

Question 6

Which of the following treatments is the most frequently used in pediatric oncology?

A) surgery
B) radiation
C) chemotherapy
D) radioactive materials

Question 7

The nurse hears the word nadir in a shift report in connection with a child's blood counts. The nurse is aware that nadir refers to which of the following concepts?

A) the point at which the child has reached a normal blood cell count and is on the road to recovery
B) the lowest point in the child's blood counts or myelosuppression, which occurs about 10 to 14 days after chemotherapy
C) the point at which the child has been free of cancer symptoms for 5 years and has more likely beaten cancer
D) a safe level of blood cell counts representing neither a high or a low in cell counts

Question 8

The nurse is assigned to a child who has a platelet count of 15,000 per cubic millimeter. The nurse realizes that which of the following is true?

A) A blood thinner such as Coumadin needs to be considered by the physician.
B) There is a serious danger of infection even from normal skin bacteria.
C) This is a normal platelet count, and there is nothing to worry about in regard to platelets.
D) The child has a high risk of spontaneous bleeding, which can be life threatening.

Question 9

When a child has thrombocytopenia, the nurse must do which of the following in regard to any intramuscular (IM) injections or venipunctures ordered?

A) Administer any IM or intravenous (IV) medication very slowly to avoid problems.
B) Apply pressure to the site for 10 minutes after administration.
C) Apply ice to any IM or IV site for 15 minutes each hour.
D) Avoid aspirating after injection, and avoid massaging the site.

Question 10

When the nurse is working with a child who has a low platelet count, the nurse will teach the family and the child to avoid which of the following?

A) engaging in contact sports or any activity that has a risk of physical injury
B) taking daily vitamins with mineral supplements or zinc supplements
C) herbal teas of any type
D) leaving the house for any reason

Question 11

The nurse working with a child in the pediatric unit gets a lab report back on the child, which shows an absolute neutrophil count (ANC) of slightly less than 500 per cubic millimeter. This ANC tells the nurse which of the following things?

A) The neutrophil count is approaching normal and the child is on the way to recovery.
B) Even normal body flora can put the child at risk for serious life-threatening bacterial infections.
C) Vital signs need to be taken at least every two hours with all temperatures taken rectally.
D) The child needs an iron-rich diet and needs to add more fresh fruits and vegetables to the diet.

Question 12

Which of the following signs or symptoms will the nurse find on assessing a child who is neutropenic and has an infection?

A) elevated temperature and complaint of a feverish feeling
B) production of pus
C) redness of inflammation
D) no signs except perhaps complaint of pain or swelling

Question 13

The nurse is working with a child who is immunosuppressed. The parents call to tell the nurse that the child has been exposed to varicella. Which of the following courses of action will the nurse suggest?

A) Call the pediatrician, and get the child prompt treatment with a varicella immune globulin within 72 hours of exposure.
B) Isolate the child, and get an order for an immunization for varicella if the child has not received the immunization.
C) Take the child to the emergency room there the doctor will begin intravenous (IV) antibiotics.
D) Take the child to the doctor's office to be seen by the nurse practitioner or the pediatrician.

Question 14

The nurse is working with an immunosuppressed child. A parent points out that the child is due to have oral poliovirus vaccine and a measles-mumps-rubella (MMR) vaccine prior to school starting. The nurse will advise the parent to do which of the following?

A) Have the child get the MMR but not the oral poliovirus.
B) Take the child to get the oral poliovirus vaccine but not the MMR.
C) Omit live viral vaccines until the child is no longer immunosuppressed.
D) Talk with the pediatrician about getting gamma globulin with the vaccines.

Question 15

The nurse assessing a child who is undergoing chemotherapy finds the child to be suffering from mucositis. Which of the following interventions would be most helpful?

A) good oral care to clean the oral cavity of food particles and debris
B) sips of ice and lubricating oil to the lips
C) a room humidifier with a eucalyptus oil added to the water
D) six to eight glasses of water every day

Question 16

A parent shares with the nurse that his child who is undergoing chemotherapy vomited on the way to the hospital and in the entrance to the outpatient clinic. The nurse will do which of the following things?

A) Cancel the chemotherapy for the day and reschedule it for another day.
B) Use interventions such as antiemetics ordered by the physician, relaxation, biofeedback, music, and distraction.
C) Talk to the physician about ordering a lower dose of chemotherapy or a less-frequent-dosage schedule.
D) Isolate the child for the next 48 hours to see what is causing the nausea and vomiting.

Question 17

A caregiver for a child who is undergoing chemotherapy for cancer shares with the nurse that the child's temperature is being taken rectally every 4 hours. Which of the following is the nurse's best response?

A) "Good for you for paying close attention to whether your child has a fever or not."
B) "Once a day, at the same time each day, is the best practice for taking the temperature."
C) "It is not necessary to take the temperature so often. You need only take the child's temperature if you suspect fever."
D) "Stop this practice, because the thermometer can cause breaks in the rectal mucosa and cause bacteria to enter the bloodstream, resulting in sepsis or abscess."

Question 18

The nurse is caring for a child who is receiving chemotherapeutic agents. Prior to administering the chemotherapy, the nurse must check which of the following and report to the physician if the results are high?

A) cardiac enzymes
B) hemoglobin and oxygen saturation levels
C) thyroxine
D) liver transaminase and bilirubin levels

Question 19

When the nurse is working with children receiving Cytoxan or ifosfamide, the nurse is aware that these children are at risk for which of the following conditions?

A) hemorrhagic cystitis during drug administration or months after administration
B) pancreatic cancer
C) severe hearing loss or complete deafness within weeks of receiving these drugs
D) retrolental fibroplasia

Question 20

A child who is undergoing chemotherapy will ask the nurse if her hair will fall out. Which of the following is the nurse's best response?

A) "Not all children lose their hair, and you may be one of the lucky ones and not lose your hair at all."
B) "Try not to think about your hair. Let's do something to keep your mind off losing your hair."
C) "The hair will probably fall out in 2 weeks or less, but it will grow back then chemotherapy is complete."
D) "Let me get you some crayons, and you can draw your feelings about losing your hair."

Question 21

The adolescent female who is receiving chemotherapy for cancer will be advised by the nurse of which of the following?

A) to advise any sexual partners not to use condoms during intercourse
B) to use pads instead of tampons during menstruation
C) that females have a greater chance of becoming sterile than their male counterparts
D) that females will have a normal pubertal development

Question 22

The nurse is giving instructions to the family of a child who has a venous access device (VAD). This child's VAD is an external catheter. Which of the following instructions will the nurse give to the family?

A) Do not force-flush the catheter at any time, and call if any problems with flushing occur.
B) The catheter needs no special dressings or coverings.
C) The child is to avoid swimming and tub baths during the entire time the vascular access device is in place.
D) Trauma to the device is highly likely, and the child must be extremely careful in any activities.

Question 23

The nurse assigned to work with the child who has had whole brain radiation assesses the child and finds that the child is sleeping up to 20 hours a day and is having some nausea and malaise, a fever, and dysphasia. Based on this assessment, the nurse will work with the parents in which of the following areas?

A) caring for the dying child
B) dealing with the side effects of radiation therapy
C) accepting a reoccurrence of the tumor
D) accepting the imminent death of their child

Question 24

Which of the following are the most common presenting signs of acute lymphocytic leukemia (ALL)?

A) blurred vision, dizziness, and changes in behaviors
B) bleeding and severe hemorrhaging
C) nodules in various locations on the body
D) fever, bone pain, pallor, and bruising

Question 25

The nurse caring for a child with acute lymphocytic leukemia is aware that once chemotherapy begins, there is a release of purines from the destroyed leukemic lymphoblasts, which can lead to which of the following problems?

A) tumor lysis syndrome
B) metastasis to the lungs
C) altered mental states
D) gout

Question 26

What is the most common type of central nervous system tumor in children?

A) medulloblastomas
B) astrocytomas
C) ependymomas
D) craniopharyngiomas

Question 27

A child is said to be a "long-term survivor" then he has been off cancer therapy for a minimum of two years and is in remission for ____________________ years.