737 Chapter 44: Cancer MULTIPLE CHOICE 1. A nursing faculty member explains to the class that which item is the most important for tumor cell growth? a. Age of transforming cells b. Programmed cell death c. Proximity to a capillary d. Rapidity of cell growth ANS: C All cells, including tumor cells, need a consistent supply of oxygen and nutrients, deliv ered via the capillaries. Neoplastic cells must be in close enough proximity to a capillary to provide these required elements. The other factors do not have such an important role, if any, in neoplastic growth. Cognitive Level: Knowledge/Remembering Cont ent Area: Pediatrics/Maternity MSC: Client Needs: Physiological Integrity: Physiological Adaptation OBJ: Nursing Process: Teaching/Learning DIF: Easy PTS: 1 2. A nursing student asks the faculty member to explain an oncogene. Which response by the faculty mem ber is the most appropriate? a. A cell that changes into a malignancy after environmental stress b. Any gene found inside a solid tumor that can be removed for biopsy c. A gene in a virus that encourages malignant transformation in cells d. An inherited gene that is programmed to become a malignant cell ANS: C An oncogene is a gene found inside a virus that has the ability to encourage a normal cell to become malignant Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity MSC: Client Needs: Physi ological Integrity: Physiological Adaptation OBJ: Nursing Process: Teaching/Learning DIF: Easy PTS: 1 3. A nurse is reviewing a patients chart and notes that the patient has a cancerous tumor that has invaded other organs. Based on this information, at which stage is this patients cancer classified? a. Stage O b. Stage I c. Stage III d. Stage IV ANS: D A stage IV cancer is one that has invaded other organs. Stage 0 is early cancer, present only in the cells in which it began. Stages I-III are more extensive, with larger tumors and spread to nearby lymph nodes or adjacent organs. Cognitive Level: Knowledge/Remembering Content Area: Pediatrics/Maternity MSC: Client Needs: Physiological Integrity: Physiological Adaptation OBJ: Nursing Process: Nursing Process: Assessment 738 DIF: Easy PTS: 1 4. A nurse hears that a new admission to the hospital was recently diagnosed with the most common kind of childhood cancer. Which collaborative care does the nurse prepare to provide to this patient? a. Antibiotic administration b. Bone marrow transplant c. Chemotherapy d. Liver transplant ANS: C The most common type of childhood cancer is acute lymphocytic leukemia (ALL). First -line treatment for ALL is inducing remission with chemotherapy. Antibiotics are not used unless the child has an infection. Bone marrow transplant may be considered later in the childs course of care. A liver transplant would not be a treatment for ALL. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity MSC: Client Needs: Physiological Integrity: Physiologi cal Adaptation OBJ: Nursing Process: Nursing Process: Implementation DIF: Moderate PTS: 1 5. A parent brings a child to the clinic and reports that the child is reluctant to walk and has a new limp. The parent also reports that the child seems lethargic and tired all the time. The nurse notes that the child appears pale. Which other finding would warrant immediate notification of the health -care provider? a. Difficulty staying asleep at night b. Left -sided abdominal enlargement c. Polyphagia and polydipsia d. Swelling of the legs and feet ANS: B This child has some manifestations of acute lymphocytic leukemia (ALL). Left -sided abdominal enlargement could be indicative of splenomegaly, which is another manifestation of this disease. The nurse should report these findings immediately. Difficulty staying asleep at night is vague and could be related to a number of causes, both physical and behavioral. Polydipsia and polyphagia are two of the three classic signs of diabetes. Swelling of the legs and feet is not a manifestatio n of ALL. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity MSC: Client Needs: Physiological Integrity: Physiological Adaptation OBJ: Nursing Process: Nursing Process: Assessment DIF: Moderate PTS: 1 6. A nurse is caring for a child who is scheduled to have intrathecal chemotherapy today. Which action by the nurse is most important when providing care to this patient and family? a. Educating family on side effects of chemotherapy b. Ensuring a signed consent is on the chart c. Providing distrac tion techniques during the process d. Reassuring the child the parents will be present ANS: B Intrathecal chemotherapy (introducing chemotherapy into the subarachnoid space of the spinal cord) is an 739 invasive procedure and requires a signed consent. Although all actions are important for this child, the priority is ensuring the consent is executed appropriately and on the chart. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity MSC: Client Needs: Safe and Effective Care Environment: Management of Care OBJ: Nursing Process: Communication and Documentation DIF: Moderate PTS: 1 7. A child is admitted and is scheduled to receive intravenous asparginase (Elspar). Which action by the nurse is most important when administering this medication? a. Arranging an outpatient hearing test b. Having emergency drugs on hand c. Monitoring the childs intake and output d. Providing anti -emetic drugs as needed ANS: B Anaphylaxis is a possible side effect of this drug. Emergency medications should be readily available. Ototoxicity can be caused by carboplatin (Paraplatin). Monitoring intake and output is important for any child on IV therapy. Anti -emetic drugs are important for any child receiving chemotherapy. Cognitive Level: Application/Applying Content Area: Pediatr ics/Maternity MSC: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies OBJ: Nursing Process: Nursing Process: Implementation DIF: Moderate PTS: 1 8. A neutropenic child is admitted to the hospital and placed in protective isolation . Which instruction does the nurse give the family to help maintain a safe environment for the child? a. Do not let the child have chewing gum b. Flowers, plants, and produce are not allowed c. The child can only have one visitor at a time d. Toys and items from home cannot be brought in ANS: B The neutropenic child should not have fresh flowers, plants, fruits, or vegetables because they can harbor infectious microorganisms. The other instructions are not needed. Cognitive Level: Application/Applying Content Area: Pediatrics/Maternity MSC: Client Needs: Safe and Effective Care Environment: Safety and Infection Control OBJ: Nursing Process: Teaching/Learning DIF: Moderate PTS: 1 9. A 7-year -old child presents to the emergency department, where the parent reports a 3-wee k history of pale skin, extreme fatigue, and dizziness. Which laboratory value would the nurse correlate with the patients current condition? a. Hematocrit: 33% b. Hemoglobin: 13.2 g/dL c. Red blood cell count: 2.8/mm3 d. White blood cell count: 12.3/mm3
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