Child Health - Oncological.txt

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bamaguh1988
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Child Health - Oncological.txt
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2015-01-08 17:13:48
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  1. The nurse is monitoring a child for bleeding after surgery for removal of a brain tumor. The nurse checks the head dressing for the presence of blood and notes a colorless drainage on the back of the dressing. Which intervention should the nurse perform immediately? 
    1. Reinforce the dressing. 
    2. Notify the health care provider (HCP). 
    3. Document the findings and continue to monitor. 
    4. Circle the area of drainage and continue to monitor.
    2. Notify the health care provider (HCP).
  2. A child undergoes surgical removal of a brain tumor. During the postoperative period, the nurse is monitoring the child and notes that the child is restless, the pulse rate is elevated, and the blood pressure has decreased significantly from the baseline value. The nurse suspects that the child is in shock. Which is the most appropriate nursing action? 
    1. Notify the health care provider (HCP). 
    2. Place the child in a supine position. 
    3. Place the child in Trendelenburg's position. 
    4. Increase the flow rate of the intravenous fluids.
    1. Notify the health care provider (HCP).
  3. The mother of a 4-year-old child tells the pediatric nurse that the child's abdomen seems to be swollen. During further assessment of subjective data, the mother tells the nurse that the child is eating well and that the activity level of the child is unchanged. The nurse, suspecting the possibility of Wilms' tumor, should avoid which during the physical assessment? 
    1. Palpating the abdomen for a mass 
    2. Assessing the urine for the presence of hematuria 
    3. Monitoring the temperature for the presence of fever 
    4. Monitoring the blood pressure for the presence of hypertension
    1. Palpating the abdomen for a mass
  4. The pediatric nurse specialist provides a teaching session to the nursing staff regarding osteosarcoma. Which statement by a member of the nursing staff indicates a need for information? 
    1. "The femur is the most common site of this sarcoma." 
    2. "The child does not experience pain at the primary tumor site." 
    3. "Limping, if a weight-bearing limb is affected, is a clinical manifestation." 
    4. "The symptoms of the disease in the early stage are almost always attributed to normal growing pains."
    2. "The child does not experience pain at the primary tumor site."
  5. The nurse analyzes the laboratory values of a child with leukemia who is receiving chemotherapy. The nurse notes that the platelet count is 19,500 cells/mm3. On the basis of this laboratory result, which intervention should the nurse include in the plan of care? 
    1. Initiate bleeding precautions. 
    2. Monitor closely for signs of infection. 
    3. Monitor the temperature every 4 hours. 
    4. Initiate protective isolation precautions.
    1. Initiate bleeding precautions.
  6. The nurse is monitoring a 3-year-old child for signs and symptoms of increased intracranial pressure (ICP) after a craniotomy. The nurse plans to monitor for which early sign or symptom of increased ICP? 
    1. Vomiting 
    2. Bulging anterior fontanel 
    3. Increasing head circumference 
    4. Complaints of a frontal headache
    1. Vomiting
  7. A 4-year-old child is admitted to the hospital for abdominal pain. The mother reports that the child has been pale and excessively tired and is bruising easily. On physical examination, lymphadenopathy and hepatosplenomegaly are noted. Diagnostic studies are being performed on the child because acute lymphocytic leukemia is suspected. The nurse understands that which diagnostic study should confirm this diagnosis? 
    1. Platelet count 
    2. Lumbar puncture 
    3. Bone marrow biopsy 
    4. White blood cell count
    3. Bone marrow biopsy
  8. A 6-year-old child with leukemia is hospitalized and is receiving combination chemotherapy. Laboratory results indicate that the child is neutropenic, and protective isolation procedures are initiated. The grandmother of the child visits and brings a fresh bouquet of flowers picked from her garden and asks the nurse for a vase for the flowers. Which response should the nurse provide to the grandmother? 
    1. "I have a vase in the utility room, and I will get it for you." 
    2. "I will get the vase and wash it well before you put the flowers in it." 
    3. "The flowers from your garden are beautiful, but should not be placed in the child's room at this time." 
    4. "When you bring the flowers into the room, place them on the bedside stand as far away from the child as possible."
    3. "The flowers from your garden are beautiful, but should not be placed in the child's room at this time."
  9. A diagnosis of Hodgkin's disease is suspected in a 12-year-old child seen in a clinic. Several diagnostic studies are performed to determine the presence of this disease. Which diagnostic test result will confirm the diagnosis of Hodgkin's disease? 
    1. Elevated vanillylmandelic acid urinary levels 
    2. The presence of blast cells in the bone marrow 
    3. The presence of Epstein-Barr virus in the blood 
    4. The presence of Reed-Sternberg cells in the lymph nodes
    4. The presence of Reed-Sternberg cells in the lymph nodes
  10. Which specific nursing interventions are implemented in the care of a child with leukemia who is at risk for infection? Select all that apply. 
    1. Maintain the child in a semiprivate room. 
    2. Reduce exposure to environmental organisms. 
    3. Use strict aseptic technique for all procedures. 
    4. Ensure that anyone entering the child's room wears a mask. 
    5. Apply firm pressure to a needle stick area for at least 10 minutes.
    • 2. Reduce exposure to environmental organisms. 
    • 3. Use strict aseptic technique for all procedures. 
    • 4. Ensure that anyone entering the child's room wears a mask.
  11. The nurse is performing an assessment on a 10-year-old child suspected to have Hodgkin's disease. The nurse understands that which assessment findings are specifically characteristic of this disease? Select all that apply. 
    1. Abdominal pain 
    2. Fever and malaise 
    3. Anorexia and weight loss 
    4. Painful, enlarged inguinal lymph nodes 
    5. Painless, firm, and movable adenopathy in the cervical area
    • 1. Abdominal pain 
    • 5. Painless, firm, and movable adenopathy in the cervical area
  12. A 6-year-old child has just been diagnosed with localized Hodgkin's disease, and chemotherapy is planned to begin immediately. The mother of the child asks the nurse why radiation therapy was not prescribed as a part of the treatment. What is the nurse's best response? 
    1. "It's very costly, and chemotherapy works just as well." 
    2. "I'm not sure. I'll discuss it with the health care provider." 
    3. "Sometimes age has to do with the decision for radiation therapy." 
    4. "The health care provider would prefer that you discuss treatment options with the oncologist."
    3. "Sometimes age has to do with the decision for radiation therapy."
  13. A 13-year-old child is diagnosed with Ewing's sarcoma of the femur. After a course of radiation and chemotherapy, it was decided that leg amputation is necessary. After the amputation, the child becomes very frightened because of aching and cramping felt in the missing limb. Which nursing statement is most appropriate to assist in alleviating the child's fear? 
    1. "The pain medication that I give you will take these feelings away." 
    2. "This aching and cramping is normal and temporary and will subside." 
    3. "This pain is not real pain, and relaxation exercises will help it go away." 
    4. "This normally occurs after the surgery, and we will teach you ways to deal with it."
    2. "This aching and cramping is normal and temporary and will subside."
  14. A 9-year-old child with leukemia is in remission and has returned to school. The school nurse calls the mother of the child and tells the mother that a classmate has just been diagnosed with chickenpox. The mother immediately calls the clinic nurse because the leukemic child has never had chickenpox. Which is an appropriate response by the clinic nurse to the mother? 
    1. "There is no need to be concerned." 
    2. "Bring the child into the clinic for a vaccine." 
    3. "Keep the child out of school for a 2-week period." 
    4. "Monitor the child for an elevated temperature, and call the clinic if this happens."
    2. "Bring the child into the clinic for a vaccine."
  15. The nurse instructs the parents of a child with leukemia regarding measures related to monitoring for infection. Which statement, if made by the parent, indicates a need for further instructions? 
    1. "I will take a rectal temperature daily." 
    2. "I will inspect the skin daily for redness." 
    3. "I will inspect the mouth daily for lesions." 
    4. "I will perform proper hand washing techniques."
    1. "I will take a rectal temperature daily."
  16. The nurse is caring for a 3-year-old boy with a diagnosis of acute lymphocytic leukemia (ALL). The child is crying and complaining that his knees hurt. Which nursing intervention is most appropriate? 
    1 .Involve the child in a diversional activity. 
    2. Ask the child if he would like a "baby aspirin." 
    3. Administer acetaminophen (Tylenol) to the child. 
    4. Apply heat to the child's knees and elevate the knees on a pillow.
    3. Administer acetaminophen (Tylenol) to the child.
  17. A 14-year-old girl is admitted to the hospital with a diagnosis of acute lymphocytic leukemia. She is receiving a combination chemotherapeutic regimen that includes cyclophosphamide. The nurse plans care understanding that which are associated with this medication? Select all that apply. 
    1. It is platelet sparing. 
    2. It causes constipation. 
    3. It causes hemorrhagic cystitis. 
    4. It causes bone marrow depression. 
    5. Increased fluid intake is necessary.
    • 1. It is platelet sparing.
    • 3. It causes hemorrhagic cystitis. 
    • 4. It causes bone marrow depression. 
    • 5. Increased fluid intake is necessary.
  18. Nursing care of the child with myelosuppression from leukemia or chemotherapeutic agents should include which intervention? 
    1. Restrict oral fluids. 
    2. Use good hand washing technique. 
    3. Give immunizations appropriate for age. 
    4. Institute strict isolation with no visitors allowed.
    2. Use good hand washing technique.
  19. The pediatric nurse clinician is discussing the pathophysiology related to childhood leukemia with a class of nursing students. Which statement made by a nursing student indicates a lack of understanding of the pathophysiology of this disease? 
    1. The platelet count is decreased. 
    2. Red blood cell production is affected. 
    3. Reed-Sternberg cells are found on biopsy. 
    4. Normal bone marrow is replaced by blast cells.
    3. Reed-Sternberg cells are found on biopsy.
  20. A nurse is caring for a 9-year-old child with leukemia who is hospitalized for the administration of chemotherapy. The nurse would monitor the child specifically for central nervous system (CNS) involvement by checking which item? 
    1. Pupillary reaction 
    2. Level of consciousness (LOC) 
    3. The presence of petechiae in the sclera 
    4. Color, motion, and sensation of the extremities
    2. Level of consciousness (LOC)
  21. The pediatric nurse assists the health care provider in performing a lumbar puncture (LP) on a 3-year-old child with leukemia and suspected central nervous system metastasis. The nurse should place the child in which position for this procedure? 
    1. Lithotomy position 
    2. Modified Sims position 
    3. Prone, with the knees flexed to the abdomen and the head bent, the chin resting on the chest 
    4. Lateral recumbent, with the knees flexed to the abdomen and the head bent, the chin resting on the chest
    4. Lateral recumbent, with the knees flexed to the abdomen and the head bent, the chin resting on the chest
  22. A 6-year-old child has just been diagnosed with localized Hodgkin's disease, and chemotherapy is planned to begin immediately. The mother of the child asks the nurse why radiation therapy was not prescribed as a part of the treatment. Which is the appropriate and supportive response to the mother? 
    1. "The child is too young to have radiation therapy." 
    2. "It's very costly, and chemotherapy works just as well." 
    3. "I'm not sure. I'll discuss it with the health care provider." 
    4. "The health care provider (HCP) would prefer that you discuss treatment options with the oncologist."
    1. "The child is too young to have radiation therapy."
  23. A diagnostic workup is being performed on a 1-year-old child with suspected neuroblastoma. The nurse reviews the results of the diagnostic tests and understands that which finding is most specifically related to this type of tumor? 
    1. Positive Babinski's sign 
    2. Presence of blast cells in the bone marrow 
    3. Projectile vomiting, usually in the morning 
    4. Elevated vanillylmandelic acid (VMA) urinary levels
    4. Elevated vanillylmandelic acid (VMA) urinary levels
  24. The nurse is collecting data on a 9-year-old child suspected of having a brain tumor. Which question should the nurse ask to elicit data related to the classic symptoms of a brain tumor? 
    1. "Do you have trouble seeing?" 
    2. "Do you feel tired all the time?" 
    3. "Do you throw up in the morning?" 
    4. "Do you have headaches late in the day?"
    3. "Do you throw up in the morning?"
  25. The nurse has reviewed the health care provider's prescriptions for a child suspected of a diagnosis of neuroblastoma and is preparing to implement diagnostic procedures that will confirm the diagnosis. What should the nurse expect to do next to assist in confirming the diagnosis? 
    1. Collect a 24-hour urine sample. 
    2. Perform a neurological assessment. 
    3. Assist with a bone marrow aspiration. 
    4. Send to the radiology department for a chest x-ray.
    1. Collect a 24-hour urine sample.
  26. The nurse is asked to prepare for the admission of a child to the pediatric unit with a diagnosis of Wilms' tumor. The nurse is developing a plan of care for the child and should include which intervention in the plan? 
    1. Monitor the temperature for hypothermia. 
    2. Monitor the blood pressure for hypotension. 
    3. Palpate the abdomen for an increase in the size of the tumor. 
    4. Inspect the urine for the presence of hematuria at each voiding.
    4. Inspect the urine for the presence of hematuria at each voiding.
  27. The nurse is providing home care instructions to the mother of a child receiving radiation therapy. Which statement by the mother indicates a need for further teaching? 
    1. "I should dress my child in loose-fitting clothing." 
    2. "I won't need to limit the amount of sun that my child gets." 
    3. "My child may experience fatigue and need more rest periods." 
    4. "I need to try to provide food and fluids to prevent dehydration."
    2. "I won't need to limit the amount of sun that my child gets."
  28. A nurse is reviewing the record of a 10-year-old child suspected of having Hodgkin's disease. Which characteristic manifestation should the nurse anticipate to be documented in the assessment notes? 
    1. Fever 
    2. Malaise 
    3. Painful lymph nodes in the supraclavicular area 
    4. Painless and movable lymph nodes in the cervical area
    4. Painless and movable lymph nodes in the cervical area
  29. The nurse is reviewing the laboratory and diagnostic test results of a child scheduled to be seen in the clinic. The nurse notes that the health care provider documented that diagnostic studies revealed the presence of Reed-Sternberg cells. The nurse prepares to assist the health care provider to discuss treatment options for which disease with the parents? 
    1. Leukemia 
    2. Neuroblastoma 
    3. Hodgkin's disease 
    4. Infectious mononucleosis
    3. Hodgkin's disease
  30. The nurse is monitoring for bleeding in a child following surgery for removal of a brain tumor. The nurse checks the head dressing and notes the presence of dried blood on the back of the dressing. The child is alert and oriented, and the vital signs and neurological signs are stable. Which nursing action is most appropriate initially? 
    1. Prepare to change the dressing. 
    2. Recheck the dressing in 1 hour. 
    3. Check the operative record to determine whether a drain is in place. 
    4. Document the findings and notify the health care provider immediately.
    3. Check the operative record to determine whether a drain is in place.
  31. A child is scheduled for allogeneic bone marrow transplantation (BMT). The parent of the child asks the nurse about the procedure. The nurse should provide which description about the BMT transplantation? 
    1. Aspiration of bone marrow from the child 
    2. Obtaining bone marrow from the child's twin 
    3. Obtaining bovine (cow) bone marrow and administering it to the child 
    4. Obtaining bone marrow from a donor who matches the child's tissue type
    4. Obtaining bone marrow from a donor who matches the child's tissue type

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