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Chapter 48 The Child with Cancer
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Chapter 48 The Child with Cancer
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Chapter 48: The Child with CancerTest Bank
MULTIPLE CHOICE
1. The nurse notes that a child’s gums bleed easily and he has bruising and petechiae on his
extremities. What laboratory values are consistent with these symptoms?
a. Platelet count of 19,000/mm3
b. Prothrombin time of 11 to 15 seconds
c. Hematocrit of 34
d. Leukocyte count of 14,000/mm3
ANS: A
Feedback
A The normal platelet count is 150,000 to 400,000/mm3. This finding is very low,
indicating an increased bleeding potential. The child should be monitored
closely for signs of bleeding.
B The prothrombin time of 11 to 15 seconds is within normal limits.
C The normal hematocrit is 35 to 45 and, although this finding is low, it would not
create the symptoms presented.
D This value indicates the probable presence of infection, but it is not a reflection
of bleeding tendency.
PTS: 1 DIF: Cognitive Level: Analysis REF: p. 1278
OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
2. The nurse understands that the type of precautions needed for children receiving
chemotherapy is based on which actions of chemotherapeutic agents?
a. Gastrointestinal upset
b. Bone marrow suppression
c. Decreased creatinine level
d. Alopecia
ANS: B
Feedback
A Although gastrointestinal upset may be an adverse effect of chemotherapy, it is
not caused by all chemotherapeutic agents. No special precautions are instituted
for gastrointestinal upset.
B Chemotherapy agents cause bone marrow suppression, which creates the need to
institute precautions related to reduced white blood cell, red blood cell, and
platelet counts. These precautions focus on preventing infection and bleeding.
C A decreased creatinine level is consistent with renal pathologic conditions, not
chemotherapy.
D Not all chemotherapeutic agents cause alopecia. No precautions are taken to
prevent alopecia.
PTS: 1 DIF: Cognitive Level: Application REF: p. 1268
, OBJ: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment
3. The nurse should base a response to a parent’s question about the prognosis of acute
lymphoblastic leukemia (ALL) on the knowledge that
a. Leukemia is a fatal disease, although chemotherapy provides increasingly longer
periods of remission.
b. Research to find a cure for childhood cancers is very active.
c. The majority of children go into remission and remain symptom free
when treatment is completed.
d. It usually takes several months of chemotherapy to achieve a remission.
ANS: C
Feedback
A With the majority of children surviving 5 years or longer, it is inappropriate to
refer to leukemia as a fatal disease.
B This statement is true, but it does not address the parent’s concern.
C Children diagnosed with the most common form of leukemia, ALL, can almost
always achieve remission, with a 5-year disease-free survival rate approaching
85%.
D About 95% of children achieve remission within the first month of
chemotherapy. If a significant number of blast cells are still present in the bone
marrow after a month of chemotherapy, a new and stronger regimen is begun.
PTS: 1 DIF: Cognitive Level: Application REF: p. 1267
OBJ: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity
4. Hematopoietic stem cell transplantation (HSCT) is the standard treatment for a child in his or
her first remission with what cancer?
a. ALL
b. Non-Hodgkin lymphoma
c. Wilms’ tumor
d. Acute myeloblastic leukemia (AML)
ANS: D
Feedback
A The standard treatment for ALL is combination chemotherapy.
B Standard treatment for non-Hodgkin lymphoma is chemotherapy. Bone marrow
transplantation is used to treat non-Hodgkin lymphoma that is resistant to
conventional chemotherapy and radiation.
C The treatment for Wilms’ tumor consists of surgery and chemotherapy alone or
in combination with radiation therapy.
D HSCT is often used interchangeably with bone marrow transplantation and is
currently standard treatment for children in their first remission with AML.
PTS: 1 DIF: Cognitive Level: Application REF: p. 1271
OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
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