Exam (elaborations)
Peds prep u neoplastic disorder
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Peds prep u Ch 28 neoplastic disorder Peds prep u Ch 28 neoplastic disorder Peds prep u Ch 28 neoplastic disorder
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Peds prep u Ch 28 neoplastic disorderA high-school football player has been diagnosed as having osteosarcoma of the femur. His mother
is angry because she told him not to play football. Which of the following health teaching points
would you include in the teaching plan for the boy and his mother?
a) He can expect some discoloration of his leg following chemotherapy.
b) Football injuries do not contribute to the development of a tumor.
c) Osteosarcoma often follows trauma, such as a football injury.
d) Tumor growth is more related to his dislike of milk. - ANS b) Football injuries do not contribute to
the development of a tumor.
Football injuries do not contribute to the development of a tumor.
The nurse caring for a 14-year-old scheduled for magnetic resonance imaging (MRI) explains how the
test works to the family. Which of the following responses accurately describes this test?
a) "The MRI uses radio waves and magnets to produce a computerized image of the body."
b) "The MRI uses sound waves to create images that visualize body structures and locate masses."
c) "The MRI uses radiation to examine soft tissue and bony structures of the body."
d) "The MRI is a nuclear scanning test to rule out cancer involving the bones or determine extent of
bone involvement." - ANS a) "The MRI uses radio waves and magnets to produce a computerized
image of the body."
The MRI uses radio waves and magnets to produce a computerized image of the body. The bone
scan is a nuclear scanning test to rule out cancer involving the bones or determine extent of bone
involvement. The ultrasound uses sound waves to create images that visualize body structures and
locate masses. Radiography uses radiation to examine soft tissue and bony structures of the body.
Parents ask why their child just diagnosed with leukemia needs a "spinal tap." Which is the best
response by the nurse?
a) "A sample of cerebrospinal fluid is needed to check for possible central nervous system
infection."
,b) "Checking the cerebrospinal fluid will reveal whether leukemic cells have entered the central
nervous system."
c) "The spinal tap will help relieve pressure and headache for your child."
d) "It will help rule out a second malignancy." - ANS b) "Checking the cerebrospinal fluid will reveal
whether leukemic cells have entered the central nervous system."
The cerebrospinal fluid is checked so the clinician can determine whether leukemic cells have
invaded the central nervous system. It is common for a chemotherapy medication, usually
methotrexate, to be administered immediately following lumbar puncture as treatment for potential
infiltration. The other responses are incorrect.
A preschooler who received chemotherapy in the pediatric oncology outpatient department 1 week
ago now has a temperature of 101.5°F (38.6°C). Which is the most appropriate response by the
nurse?
a) Have the parent bring the child to the pediatric oncology clinic as soon as possible
b) Tell the parent to administer acetaminophen every 4 hours until the fever dissipates
c) Instruct the parent to immediately obtain and give the antibiotic that the oncologist will order
d) Ask whether any family members or other close associates are ill - ANS a) Have the parent bring
the child to the pediatric oncology clinic as soon as possible
The preschooler is considered immune suppressed following recent chemotherapy. A fever can
mean sepsis, which would require immediate investigation of blood and other body fluids to identify
the organism, plus prompt treatment with an IV antibiotic. This can be accomplished only by seeing
the pediatric oncologist and is likely to result in hospitalization.
A 10-year-old who is receiving chemotherapy has received ondansetron before this therapy session.
About an hour later, the child tells the nurse that his mouth feels really dry. The child has urinated
several times and his skin turgor is normal. Which response by the nurse would be most
appropriate?
a) "Let me increase your intravenous fluids."
b) "This indicates an infection. We need to start antibiotics."
c) "The drug you got to help with the nausea can cause dry mouth."
d) "You might be having a severe allergic reaction. Are you itchy?" - ANS c) "The drug you got to help
with the nausea can cause dry mouth."
,Ondansetron is associated with dry mouth. Increasing IV fluids may or may not be appropriate. The
child is urinating and his skin turgor is normal so it doesn't appear that he is dehydrated and in need
of extra fluid. A severe allergic reaction would more likely be manifested by itching, hives, and
increasing respiratory distress. Dry mouth is not an indicator of infection.
How can the nurse most simply describe for distressed parents a rhabdomyosarcoma that has been
found in their 5-year-old?
a) Indicate that the more commonly used name is Hodgkin's disease
b) Call it a tumor of muscle tissue
c) Explain that it develops in nerves outside the brain and spinal cord
d) Describe it as a bone tumor - ANS b) Call it a tumor of muscle tissue
A rhabdomyosarcoma is a tumor of striated muscle that most commonly develops in the head, neck,
arms, and legs, as well as in the genitourinary tract, of children. The other descriptors are incorrect
The father of an 8-year-old boy who is receiving radiation therapy is upset that his son has to go
through 6 weeks of treatments. He doesn't understand why it takes so long. In explaining the need
for radiation over such a long time, which of the following should the nurse mention?
a) Insurance companies typically allow only a short radiation treatment per week, to contain costs
b) Cells are only susceptible to treatment by radiation during certain phases of the cell cycle
c) It is difficult to locate where the cancer cells are in the body, so the entire body must be
irradiated
d) Radiation therapy is very weak, and therefore it takes a long time to achieve therapeutic doses -
ANS b) Cells are only susceptible to treatment by radiation during certain phases of the cell cycle
Radiation is not effective on cells that have a low oxygen content (a proportion of cells in every
tumor), nor is it effective at the time of cell division (mitosis). Therefore, radiation schedules are
designed so that therapy occurs over a period of 1 to 6 weeks and includes time intervals when cells
will be in a susceptible stage.
, The nurse is teaching the parents of a 15-year-old boy who is being treated for acute myelogenous
leukemia about the side effects of chemotherapy. For which symptoms should the parents seek
medical care immediately?
a) Temperature of 101° F (38.3° C) or greater
b) Earache, stiff neck, or sore throat
c) Blisters, ulcers, or a rash appear
d) Difficulty or pain when swallowing - ANS a) Temperature of 101° F (38.3° C) or greater
The parents should seek medical care immediately if the child has a temperature of 101°F (38.3° C)
or greater. This is because many chemotherapeutic drugs cause bone marrow suppression; the
parents must be directed to take action at the first sign of infection in order to prevent
overwhelming sepsis. The appearance of earache, stiff neck, sore throat, blisters, ulcers, or rashes, or
difficulty or pain when swallowing are reasons to seek medical care, but are not as grave as the risk
of infection
Children who are free of acute lymphocytic anemia for 2 years following treatment are considered
cured.
a) True
b) False - ANS b) False
Children who are free of disease for 4 years are considered cured, and their maintenance therapy
can then be stopped.
Nursing students are reviewing information about childhood cancers. They demonstrate
understanding of the information when they identify which of the following as the most frequent
type?
a) Brainstem tumor
b) Non-Hodgkin's lymphoma
c) Wilms' tumor
d) Leukemia - ANS d) Leukemia
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