Question 1

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.)

Accepted Answer

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.

Question 2

The nurse is teaching a community group about early warning signs of cancer.Which signs does the nurse include? (Select all that apply.)

Accepted Answer

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.

Question 3

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.)

Accepted Answer

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.

Question 4

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.)

Accepted Answer

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.

Question 5

A child has been admitted with a paraspinal Ewing's sarcoma.The nursing instructor questions the student about assessing for signs of spinal cord compression.Which manifestations does this include? (Select all that apply.)

Accepted Answer

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.

Question 6

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 child's diet? (Select all that apply.)

Accepted Answer

The child with cancer needs optimal nutrition,including a diet high in calories,fatty acids,vitamins,protein,and minerals.

Question 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.)

Accepted Answer

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.

Question 8

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.)

Accepted Answer

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.

Question 9

The student nurse studying childhood cancers understands that neoplasms are caused by which factors? (Select all that apply.)

Accepted Answer

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.

Question 10

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.)

Accepted Answer

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.

Question 11

The nurse is explaining types of solid tumors to a group of students.Which information does the nurse include? (Select all that apply.)

Accepted Answer

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.

Question 12

A child is getting induction therapy for Burkitt lymphoma.The nurse finds the child lethargic and complaining of side and back pain.The child's 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.)

Accepted Answer

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 child's 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.

Question 13

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.)

Accepted Answer

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.

Question 14

A nurse is caring for several patients with acute lymphocytic leukemia (ALL).Which children does the nurse understand have the best prognosis?

Accepted Answer

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.

Question 15

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.)

Accepted Answer

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.

Quiz 33: Caring for the Child With Cancer

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.)