Cancer

Question 1

The nurse is providing care for a pediatric client who is diagnosed with a Wilms tumor.
Which laboratory test result should the nurse monitor prior to administering the prescribed
chemotherapy dose?
1. Hemoglobin
2. Red blood cell count
3. Platelets
4. Absolute neutrophil count (ANC)

Answer 1

4. Absolute neutrophil count (ANC)
   Explanation:
5. Hemoglobin indicates oxygen-carrying capacity, not immune response.
6. Red blood cell count has no correlation with immune function.
7. Platelets are associated with clotting, not immune function.
8. The absolute neutrophil count uses both the segmented (mature) and bands (immature)
   neutrophils as a measure of the body’s infection-fighting capability.

Question 2

Which general manifestations should the nurse monitor for when conducting a physical
assessment for a pediatric client who is diagnosed with cancer? Select all that apply.
1. Infection
2. Polycythemia
3. Petechiae
4. Pain
5. Cachexia

Answer 2

1. Infection
2. Petechiae
3. Pain
4. Cachexia
   Explanation:
5. Infection is often a general manifestation associated with cancer caused by altered
   immune function.
6. Anemia, not polycythemia, is a general manifestation associated with cancer.
7. Hemorrhagic spots, or petechiae, are general manifestations associated with cancer.
8. Pain is often a general manifestation of cancer resulting from neoplasms directly or
   indirectly affecting nerve receptors.
9. Cachexia is a state that is often associated with cancer. Specific symptoms include
   anorexia, nausea, and vomiting.

Question 3

Which is a therapeutic nursing response when the mother of a pediatric client diagnosed
with cancer states, “I regret not seeking medical attention earlier for my child.”?
1. “You may feel guilty, but you should not blame yourself.”
2. “Most cancers can be treated easily.”
3. “Many types of cancer are difficult to diagnose and might not show early symptoms.”
4. “Early diagnosis is not significant in the diagnosis and management of cancer.”

Answer 3

3. Many types of cancer are difficult to diagnose and might not show early symptoms

Question 4

A child diagnosed with cancer is prescribed chemotherapy. Recent laboratory data show a
low white blood cell (WBC) count. Which prescription should the nurse anticipate based on
the current data?
1. Epoetin alfa (Epogen)
2. Ondansetron (Zofran)
3. Oprelvekin (Neumega)
4. Filgrastim (Neupogen)

Answer 4

4. Filgrastim (Neupogen)
   Explanation:
5. Epoetin alfa (human recombinant erythropoietin) stimulates red blood cell (RBC)
   production.
6. Ondansetron (Zofran) is an antiemetic.
7. Oprelvekin (Neumega) increases platelets.
8. Filgrastim (Neupogen) increases production of neutrophils, a specific WBC, by the bone
   marrow.

Question 5

Which urine specific gravity, and corresponding pH, should the nurse include in a goal
statement for a pediatric client receiving chemotherapy in the treatment of cancer?
1. Specific gravity 1.030 and pH 7.5
2. Specific gravity 1.005 and pH 6
3. Specific gravity 1.030 and pH 6
4. Specific gravity 1.005 and pH 7.5

Answer 5

4. Specific gravity 1.005 and PH 7.5
   Explanation:
5. A specific gravity higher than 1.010 can mean fluid intake is not high enough.
6. A pH of less than 7 means acidosis.
7. A specific gravity higher than 1.010 can mean fluid intake is not high enough, and a pH
   of less than 7 means acidosis.
8. Because the breakdown of malignant cells releases intracellular components into the
   blood and electrolyte imbalance causes metabolic acidosis, the patient should remain
   well hydrated, with the urine specific gravity at less than 1.010 and the pH at 7.0 to 7.5.

Question 6

The nurse is preparing to administer a prescribed, as needed, antiemetic drug for a child
who is diagnosed with cancer. Which action by the nurse is most appropriate?
1. Administering the drug only if the child is nauseated
2. Administering the drug prophylactically prior to the next dose of chemotherapy
3. Administering the drug after the next dose of chemotherapy
4. Administering the drug only if the child is experiencing diarrhea

Answer 6

2. Administering the drug prophylactically prior to the next dose of chemotherapy
3. Administering the prn dose of the antiemetic drug only if the child is nausea is not the
   best use of this medication.
4. The antiemetic should be administered before chemotherapy and every 4 hours during
   the administration of chemotherapy, as a prophylactic measure.
5. Administering the prn dose of the antiemetic drug after the next dose of chemotherapy
   may not provide adequate coverage for nausea.
6. Antiemetic drugs are not administered to treat diarrhea. They are administered to treat
   nausea and vomiting.

Question 7

7) Which nursing intervention is contraindicated for a pediatric client who is experiencing
thrombocytopenia secondary to chemotherapy treatments?
1. Administering intramuscular injections
2. Monitoring intake and output
3. Palpating during the assessment
4. Providing oral hygiene

Answer 7

1. Administering IM injections
   Explanation:
2. When the child is thrombocytopenic (decreased platelets) from chemotherapy, the nurse
   should not administer intramuscular injections because of the risk of bleeding.
3. Monitoring intake and output is not contraindicated for a pediatric client who is
   experiencing thrombocytopenia as a result of chemotherapy treatments.
4. Palpation during the assessment is not contraindicated due to thrombocytopenia. This
   action is contraindicated for a child who is diagnosed with Wilms tumor.
5. Providing oral hygiene is not contraindicated for a pediatric client who is experiencing
   thrombocytopenia as a result of chemotherapy treatments.

Question 8

The child is receiving chemotherapy for acute lymphocytic leukemia (ALL). Which
assessment data should the nurse immediately report to the healthcare provider due to a
metabolic emergency?
1. Thrombocytopenia
2. Leukocytosis
3. Oliguria
4. Edema

Answer 8

3. Oliguria
   Explanation:
4. Thrombocytopenia is a clinical manifestation associated with a hematologic, not
   metabolic, emergency.
5. Leukocytosis is a clinical manifestation associated with a hematologic, not metabolic,
   emergency.
6. Tumor lysis causes a metabolic emergency caused by an electrolyte imbalance. Clinical
   manifestations associated with this include oliguria and altered levels of consciousness.
7. Edema is not indicative of a metabolic emergency

Question 9

The adolescent client is receiving methotrexate chemotherapy after undergoing limb-
salvage surgery for osteogenic sarcoma. The healthcare provider also prescribes leucovorin
therapy. Which adolescent statement indicates correct understanding for the administration
schedule for this newly prescribed drug?
1. “I do not have any pain, so I will not need to take the leucovorin this time.”
2. “I do not have any nausea, so I .will not need the leucovorin.”
3. “I am glad I only need one dose of the leucovorin.”
4. “It is important that I receive my leucovorin on time, as it protects my body from the
methotrexate.”

Answer 9

4. “It is important that I receive my leucovorin on time, as it protects my body from the methotrexate.”
   Explanation:
5. Leucovorin is not administered for pain.
6. Leucovorin is administered for nausea.
7. One dose is not the recommended therapy.
8. Leucovorin (citrovorum factor) is a form of folic acid that helps to protect normal cells
   from the destructive action of methotrexate. It is started within 24 hours of methotrexate
   administration and is given along with hydration therapy. Usual administration is every
   6 hours times 72 hours or until serum methotrexate is at the desired level.

Question 10

The sibling of a pediatric client diagnosed with leukemia expresses feelings of anger and
guilt to the nurse. Which explanation should the nurse provide to the client’s parents
regarding the reaction of the sibling?
1. Abnormal; the sibling should be referred to a psychologist.
2. Unexpected; the cancer is easily treated.
3. Unusual; the illness does not affect the sibling.
4. Normal; the sibling is affected, too, and anger and guilt are expected feelings.

Answer 10

4. Normal; The sibling is affected , too, and anger and guilt are expected feelings

Question 11

The nurse is providing care to a pediatric client who is receiving chemotherapy to treat
acute lymphocytic leukemia (ALL). Which nursing diagnoses should the nurse include in
the plan of are based on the side effects associated with the treatment? Select all that apply.
1. Risk for Injury
2. Impaired Skin Integrity
3. Risk for Electrolyte Imbalance
4. Risk for Infection
5. Sleep Deprivation

Answer 11

1. Risk for injury
2. Impaired skin integrity
3. Risk for electrolyte imbalance
4. Risk for infection

Question 12

Which is the priority nursing intervention for a pediatric client, diagnosed with leukemia,
who has a granulocyte count of 250/mm 3 and a platelet count of 150,000/mm 3 ?
1. Fluid restriction
2. Mouth care
3. Neutropenic precautions
4. Hand hygiene

Answer 12

4. Hand hygiene
   Explanation:
5. A fluid restriction is not a priority nursing intervention based on the current data. Fluids
   should continue to be encouraged.
6. Platelet count is normal; mouth care should include brushing with a soft toothbrush and
   frequent rinsing.
7. The child should be isolated from anyone infectious, but neutropenic isolation is not
   necessary.
8. Hand hygiene is vital for preventing the spread of infection.

Question 13

A child with rhabdomyosarcoma is prescribed radiation therapy after surgical removal of
the tumor. Which intervention should the nurse include in the child’s plan of care?
1. Apply lotion to the area before radiation therapy.
2. Apply sunscreen to the area when the child is exposed to sunlight.
3. Remove any markings left after each radiation treatment.
4. Vigorously scrub the area when bathing the child.

Answer 13

2. Apply sunscreen to the area when the child is exposed to sunlight

Question 14

The child is admitted to the hospital unit newly diagnosed with retinoblastoma. Which
clinical manifestation does the nurse anticipate upon assessment?
1. A white reflex
2. Blue-tinged sclerae
3. A red reflex
4. Yellow-tinged sclerae

Answer 14

1. A white reflex
   Explanation:
2. The first sign of retinoblastoma is a white pupil. The red reflex is absent. This is known
   as leukocoria, or “cat’s eye” reflex.
3. Blue-tinged sclerae are a sign of osteogenesis imperfecta, not retinoblastoma.
4. Red reflex is absent in retinoblastoma.
5. Yellow sclerae are a sign of jaundice, not retinoblastoma.

Question 15

A preschool-age child is being seen in the oncology clinic. Which reaction should the nurse
anticipate based on the child’s stage of development?
1. Unawareness of the illness and its severity
2. Acceptance, especially if able to discuss the disease with children their own age
3. Understanding of what cancer is and how it is treated
4. Thoughts that they caused their illness and are being punished

Answer 15

4. Thoughts that they caused their illness and are being punished
   Explanation:
5. Infants and toddlers are unaware of the severity of the disease.
6. Immediate acceptance will not occur with children of any age. Adolescents find contact
   with others who have gone through their experience helpful.
7. School-age children can understand a diagnosis of cancer.
8. Preschool-age children are egocentric and have magical thinking, and thus they might
   believe they caused their own illness.

Question 16

A pediatric client diagnosed with cancer is to receive 2 months of chemotherapy that is
separated by a 6-week period. The mother asks why the child cannot receive the medication
for 2 months straight. Which rationale should the nurse include when responding to the
client’s mother?
1. Prevention of nausea and vomiting from the drugs
2. Schedule requirement of the infusion center
3. Decrease incidence of heart failure
4. Allows normal cells to repair themselves while the cancer cells die

Answer 16

4. Allows normal cells to repair themselves while the cancer cells die
   Explanation:
5. The 6-week break will not decrease the side effects of nausea and vomiting.
6. Necessary treatment should never be delayed for the convenience of the medical
   personnel.
7. The 6-week break is not to decrease the incidence of heart failure, as this is not an
   adverse effect to chemotherapy.
8. Cancer cells have lost the ability to repair themselves, so medications allow the normal
   cells to repair while the cancer cells die.

Question 17

The parent of a child diagnosed with Ewing sarcoma asks why multiple drugs are needed to
treat this cancer. Which rationale should the nurse use when responding to the client’s
mother?
1. The prescribed drug protocol is needed due to the aggressive nature of the cancer.
2. The prescribed drug protocol decreases side effects.
3. The prescribed drug protocol is used in specifically in children.
4. The prescribed drug protocol involves a group of drugs that work in different modes.

Answer 17

4. The prescribed drug protocol involves a group of drugs that work in different modes.

Question 18

An adolescent female client, diagnosed with osteosarcoma, has a below-the-knee
amputation as part of the treatment regimen. Which behavior, assessed by the nurse,
indicates the client is beginning to accept the amputation?
1. Complaints of pain in the missing leg
2. Insists that a prosthetic be applied prior to participating in physical therapy.
3. Insists on covering the lower portion of the body prior to peer visitation.
4. Watches the dressing change

Answer 18

4. Watches the dressing change

Question 19

A school-age child, diagnosed with rhabdomyosarcoma, is experiencing nausea and
vomiting related to the prescribed chemotherapy in spite of the use of antiemetics. The
mother is pushing the child to eat the food. Which statement by the nurse is appropriate to
address this situation?
1. “Since your child is receiving IV fluids, it is not important to push oral intake of food.”
2. “A food aversion may occur if you continue to force your child to eat.”
3. “Emesis that is caused by your child being force-fed can damage the stomach.”
4. “A psychologic conflict could occur between you and your child if you continue to push
eating.”

Answer 19

2. “A food aversion may occur if you continue to force your child to eat.”
   Explanation:
3. Intravenous fluids do not replace normal food intake.
4. If the child is forced to eat and then vomits, the child can develop a food aversion in
   which the child associates that food with vomiting.
5. Vomiting is unpleasant but does not usually lead to stomach damage.
6. This is not a correct statement. Parents and children often disagree, but the child will
   still relate to the parent.

Question 20

The school-age child, diagnosed with a medulloblastoma, will receive intrathecal
chemotherapy injections after surgery. Which rationale for this type of chemotherapy
administration should the nurse include in the medication teaching?
1. It reduces side effects.
2. It does not require the child being “stuck.”
3. Many chemotherapy drugs do not cross the blood–brain barrier.
4. Intrathecal administration is less expensive than intravenous administration.

Answer 20

3. Many chemotherapy drugs do not cross the BBB.
   Explanation:
4. Intrathecal administration does not reduce side effects.
5. Intrathecal administration is through a spinal tap, so the child will be “stuck” for
   administration.
6. This is correct for the selection of intrathecal administration of chemotherapy.
7. This is not accurate and would not be a reason to change administration modes.

Question 21

The school-age child is admitted to the pediatric neurologic unit with a suspected
craniopharyngioma. Which assessment data collected by the nurse supports the suspected
diagnosis? Select all that apply.
1. Evening nausea
2. Excessive urination
3. Nystagmus
4. Headaches
5. Orbital ecchymosis

Answer 21

2. Excessive urination
3. Nystagmus
4. Headaches
   Explanation:
5. Nausea is a common symptom of a brain tumor due to effect on the vomiting center of
   the brain. However, it occurs primarily in the morning on arising.
6. Diabetes insipidus is common in tumors involving the pituitary gland, such as
   craniopharyngioma.
7. Nystagmus is a symptom of pressure on the optic nerve chiasm.
8. The headaches may be due to the increased bulk in the cranium and/or the ventricular
   blockage leading to hydrocephalus.
9. Orbital ecchymosis is seen in neuroblastoma secondary to metastasis to the bone.

Question 22

Which nursing actions will decrease the risk of extravasation when administering
chemotherapy to a pediatric client through a peripheral line? Select all that apply.
1. Ensuring that the intravenous line is a free flowing line
2. Administering the medication by infusion pump
3. Checking for blood return before and during chemotherapy administration
4. Diluting the medication with normal saline
5. Administering the vesicant drug last

Answer 22

1. Ensuring that the IV line is free flowing line
2. Checking for blood return before and during chemotherapy administration
3. This is critical, as extravasation is leaking into the tissues.
4. An infusion pump does not ensure that the line is free flowing; this is inappropriate.
5. This checks for intravenous administration and is appropriate.
6. Not all medications can be mixed with normal saline, and this does not protect against
   extravasation.
7. The vesicant drug should be administered first.

Question 23

The nurse is preparing to assist with a lumbar puncture for a pediatric client who is
diagnosed with cancer. Which statements should the nurse include in the teaching session for the
client and family? Select all that apply.
1. “This procedure assesses the bone marrow.”
2. “This procedure assesses cerebrospinal fluid.”
3. “This procedure confirms the diagnosis of acute lympoblastic leukemia.”
4. “The procedure determines if malignant cells are affecting the nervous system.”
5. “This procedure assesses cellular components of the blood.”

Answer 23

2. “This procedure assesses CSF.”
3. “This procedure determines if malignant cells are affecting the nervous system.”
   Explanation:
4. A bone marrow aspiration, not a lumbar puncture, is used to assess bone marrow.
5. A lumbar puncture is used to assess cerebrospinal fluid.
6. A bone marrow aspiration, not a lumbar puncture, is used to confirm the diagnosis of
   acute lymphoblastic leukemia.
7. A lumbar puncture is used to assess if malignant cells are affecting the central nervous
   system.
8. A complete blood count with differential, not a lumbar puncture, is used to assess the
   cellular components of the blood.

Question 24

Which assessment findings, indicative of a hematologic emergency, should the nurse report
to the healthcare provider due to the need for immediate intervention? Select all that apply.
1. Anemia
2. Thrombocytopenia
3. Disseminated intravascular coagulation
4. Cardiac arrhythmias
5. Tetany

Answer 24

1. Anemia
2. Thrombocytopenia
3. DIC
   Explanation:
4. Anemia is a clinical manifestation associated with a hematologic emergency
   necessitating the need for immediate intervention.
5. Thrombocytopenia is a clinical manifestation associated with a hematologic emergency
   necessitating the need for immediate intervention.
6. Disseminated intravascular coagulation is a clinical manifestation associated with a
   hematologic emergency necessitating the need for immediate intervention.
7. Cardiac arrhythmias are associated with metabolic, not hematologic, emergencies.
8. Tetany is associated with metabolic, not hematologic, emergencies.

Question 25

Which pediatric cancer diagnoses necessitate priority assessment by the nurses for clinical
manifestations associated with emergencies related to space-occupying lesions? Select all that
apply.
1. Hodgkin disease
2. Leukemia
3. Neuroblastoma
4. Melanoma
5. Lymphoma

Answer 25

1. Hodgkin disease
2. Neuroblastoma
3. Lymphoma
   Explanation:
4. A pediatric client diagnosed with Hodgkin disease is at risk for emergencies related to
   space-occupying lesions.
5. Leukemia is not a pediatric cancer associated with emergencies related to space-
   occupying lesions.
6. A pediatric client diagnosed with neuroblastoma is at risk for emergencies related to
   space-occupying lesions.
7. Melanoma is not a pediatric cancer associated with emergencies related to space-
   occupying lesions.
8. A pediatric client diagnosed with lymphoma is at risk for emergencies related to space-
   occupying lesions.

Question 26

The nurse is providing care to a pediatric client who will require surgery as a portion of the
treatment regimen. Which topics should the nurse include in the teaching session related to long-
term ramifications associated with this treatment option?
1. Scoliosis
2. Adhesions
3. Hypothyroidism
4. Visual impairment
5. Cardiotoxicity

Answer 26

2. Adhesions
3. Visual impariment
   Explanation:
4. Scoliosis is a long-term ramification associated with radiation, not surgical, intervention
   for cancer.
5. Adhesions are a long-term ramification associated with surgical intervention for cancer.
6. Hypothyroidism is a long-term ramification associated with radiation, not surgical,
   intervention for cancer.
7. Visual impairment is a long-term ramification associated with surgical intervention for
   cancer.
8. Cardiotoxicity is a long-term ramification associated with radiation, not surgical,
   intervention for cancer.

Question 27

27) The nurse is providing care to a pediatric client who will require radiation as a portion of the
treatment regimen. Which topics should the nurse include in the teaching session related to long-
term ramifications associated with this treatment option?
1. Scoliosis
2. Adhesions
3. Hypothyroidism
4. Visual impairment
5. Cardiotoxicity

Answer 27

1. Scoliosis
2. Hypothyroidism
3. Cardiotoxicity