Chapter 24 My Nursing Test Banks

Ball/Bindler/Cowen, Principles of Pediatric Nursing: Caring for Children 6th Edition Test Bank
Chapter 24

Question 1

Type: MCSA

A child diagnosed with a Wilms tumor is prescribed chemotherapy. Which laboratory test will the nurse monitor prior to administering the chemotherapy to determine the childs infection-fighting capability?

1. Hemoglobin

2. Red-blood-cell count

3. Absolute neutrophil count (ANC)

4. Platelets

Correct Answer: 3

Rationale 1: The absolute neutrophil count uses both the segmented (mature) and bands (immature) neutrophils as a measure of the bodys infection-fighting capability. Red-blood-cell count, hemoglobin, and platelets cannot determine infection-fighting capabilities.

Rationale 2: The absolute neutrophil count uses both the segmented (mature) and bands (immature) neutrophils as a measure of the bodys infection-fighting capability. Red-blood-cell count, hemoglobin, and platelets cannot determine infection-fighting capabilities.

Rationale 3: The absolute neutrophil count uses both the segmented (mature) and bands (immature) neutrophils as a measure of the bodys infection-fighting capability. Red-blood-cell count, hemoglobin, and platelets cannot determine infection-fighting capabilities.

Rationale 4: The absolute neutrophil count uses both the segmented (mature) and bands (immature) neutrophils as a measure of the bodys infection-fighting capability. Red-blood-cell count, hemoglobin, and platelets cannot determine infection-fighting capabilities.

Global Rationale: The absolute neutrophil count uses both the segmented (mature) and bands (immature) neutrophils as a measure of the bodys infection-fighting capability. Red-blood-cell count, hemoglobin, and platelets cannot determine infection-fighting capabilities.

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO 24.2 Synthesize information about diagnostic tests and clinical therapy for cancer to plan comprehensive care for children undergoing these procedures.

Question 2

Type: MCSA

A child diagnosed with cancer is prescribed chemotherapy. The latest lab value indicates the white-blood-cell count is very low. Which medication order does the nurse anticipate?

1. Filgrastim (Neupogen)

2. Ondansetron (Zofran)

3. Oprelvekin (Neumega)

4. Epoetin alfa (human recombinant erythropoietin)

Correct Answer: 1

Rationale 1: Filgrastim (Neupogen) increases production of neutrophils by the bone marrow. Ondansetron (Zofran) is an antiemetic, oprelvekin (Neumega) increases platelets, and epoetin alfa (human recombinant erythropoietin) stimulates red-blood-cell (RBC) production.

Rationale 2: Filgrastim (Neupogen) increases production of neutrophils by the bone marrow. Ondansetron (Zofran) is an antiemetic, oprelvekin (Neumega) increases platelets, and epoetin alfa (human recombinant erythropoietin) stimulates red-blood-cell (RBC) production.

Rationale 3: Filgrastim (Neupogen) increases production of neutrophils by the bone marrow. Ondansetron (Zofran) is an antiemetic, oprelvekin (Neumega) increases platelets, and epoetin alfa (human recombinant erythropoietin) stimulates red-blood-cell (RBC) production.

Rationale 4: Filgrastim (Neupogen) increases production of neutrophils by the bone marrow. Ondansetron (Zofran) is an antiemetic, oprelvekin (Neumega) increases platelets, and epoetin alfa (human recombinant erythropoietin) stimulates red-blood-cell (RBC) production.

Global Rationale: Filgrastim (Neupogen) increases production of neutrophils by the bone marrow. Ondansetron (Zofran) is an antiemetic, oprelvekin (Neumega) increases platelets, and epoetin alfa (human recombinant erythropoietin) stimulates red-blood-cell (RBC) production.

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: LO 24.2 Synthesize information about diagnostic tests and clinical therapy for cancer to plan comprehensive care for children undergoing these procedures.

Question 3

Type: MCSA

A preschool child is seen in the clinic, and the nurse anticipates a diagnosis of leukemia. Which reaction does the nurse anticipate this child will exhibit upon diagnosis?

1. Acceptance, especially if able to discuss the disease with children their own age

2. Thoughts that they caused their illness and are being punished

3. Understanding of what cancer is and how it is treated

4. Unawareness of the illness and its severity

Correct Answer: 2

Rationale 1: Preschool-age children may think they caused their illness. Adolescents find contact with others who have gone through their experience helpful. School-age children can understand a diagnosis of cancer. Infants and toddlers are unaware of the severity of the disease.

Rationale 2: Preschool-age children may think they caused their illness. Adolescents find contact with others who have gone through their experience helpful. School-age children can understand a diagnosis of cancer. Infants and toddlers are unaware of the severity of the disease.

Rationale 3: Preschool-age children may think they caused their illness. Adolescents find contact with others who have gone through their experience helpful. School-age children can understand a diagnosis of cancer. Infants and toddlers are unaware of the severity of the disease.

Rationale 4: Preschool-age children may think they caused their illness. Adolescents find contact with others who have gone through their experience helpful. School-age children can understand a diagnosis of cancer. Infants and toddlers are unaware of the severity of the disease.

Global Rationale: Preschool-age children may think they caused their illness. Adolescents find contact with others who have gone through their experience helpful. School-age children can understand a diagnosis of cancer. Infants and toddlers are unaware of the severity of the disease.

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub: 

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO 24.5 Plan care for children and adolescents of all ages who have a diagnosis of leukemia.

Question 4

Type: MCSA

The nurse is monitoring the urine specific gravity and pH on a child receiving chemotherapy. Which urinalysis result is the goal for this child?

1. Spec gravity 1.030; pH 6

2. Spec gravity 1.030; pH 7.5

3. Spec gravity 1.005; pH 6

4. Spec gravity 1.005; pH 7.5

Correct Answer: 4

Rationale 1: Because the breakdown of malignant cells releases intracellular components into the blood and electrolyte imbalance causes metabolic acidosis, the urine specific gravity should remain at less than 1.010 and the pH at 7 to 7.5. A specific gravity higher than 1.010 can mean fluid intake is not high enough, and a pH of less than 7 means acidosis.

Rationale 2: Because the breakdown of malignant cells releases intracellular components into the blood and electrolyte imbalance causes metabolic acidosis, the urine specific gravity should remain at less than 1.010 and the pH at 7 to 7.5. A specific gravity higher than 1.010 can mean fluid intake is not high enough, and a pH of less than 7 means acidosis.

Rationale 3: Because the breakdown of malignant cells releases intracellular components into the blood and electrolyte imbalance causes metabolic acidosis, the urine specific gravity should remain at less than 1.010 and the pH at 7 to 7.5. A specific gravity higher than 1.010 can mean fluid intake is not high enough, and a pH of less than 7 means acidosis.

Rationale 4: Because the breakdown of malignant cells releases intracellular components into the blood and electrolyte imbalance causes metabolic acidosis, the urine specific gravity should remain at less than 1.010 and the pH at 7 to 7.5. A specific gravity higher than 1.010 can mean fluid intake is not high enough, and a pH of less than 7 means acidosis.

Global Rationale: Because the breakdown of malignant cells releases intracellular components into the blood and electrolyte imbalance causes metabolic acidosis, the urine specific gravity should remain at less than 1.010 and the pH at 7 to 7.5. A specific gravity higher than 1.010 can mean fluid intake is not high enough, and a pH of less than 7 means acidosis.

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO 24.2 Synthesize information about diagnostic tests and clinical therapy for cancer to plan comprehensive care for children undergoing these procedures.

Question 5

Type: MCSA

The antiemetic drug ondansetron (Zofran) is administered to a child receiving chemotherapy. When should the nurse administer this medication?

1. Only if the child experiences nausea

2. After the chemotherapy has been administered

3. Before chemotherapy administration as a prophylactic measure

4. Never; this antiemetic is not effective for controlling nausea and vomiting associated with chemotherapy.

Correct Answer: 3

Rationale 1: The antiemetic ondansetron (Zofran) should be administered before chemotherapy as a prophylactic measure. Giving it after the child has nausea or at the end of chemotherapy treatment does not help with preventing nausea. It is the drug of choice for controlling nausea caused by chemotherapy agents.

Rationale 2: The antiemetic ondansetron (Zofran) should be administered before chemotherapy as a prophylactic measure. Giving it after the child has nausea or at the end of chemotherapy treatment does not help with preventing nausea. It is the drug of choice for controlling nausea caused by chemotherapy agents.

Rationale 3: The antiemetic ondansetron (Zofran) should be administered before chemotherapy as a prophylactic measure. Giving it after the child has nausea or at the end of chemotherapy treatment does not help with preventing nausea. It is the drug of choice for controlling nausea caused by chemotherapy agents.

Rationale 4: The antiemetic ondansetron (Zofran) should be administered before chemotherapy as a prophylactic measure. Giving it after the child has nausea or at the end of chemotherapy treatment does not help with preventing nausea. It is the drug of choice for controlling nausea caused by chemotherapy agents.

Global Rationale: The antiemetic ondansetron (Zofran) should be administered before chemotherapy as a prophylactic measure. Giving it after the child has nausea or at the end of chemotherapy treatment does not help with preventing nausea. It is the drug of choice for controlling nausea caused by chemotherapy agents.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: LO 24.2 Synthesize information about diagnostic tests and clinical therapy for cancer to plan comprehensive care for children undergoing these procedures.

Question 6

Type: MCSA

A child is diagnosed with thrombocytopenia secondary to chemotherapy treatments. Which action by the nurse is the most appropriate?

1. Administer intramuscular injections (IM).

2. Perform oral hygiene.

3. Monitor intake and output.

4. Use palpation as a component of assessment.

Correct Answer: 1

Rationale 1: When the child is thrombocytopenic (decreased platelets) from chemotherapy, the nurse should not administer IM injections because of the risk of bleeding. Oral hygiene care should be done with a soft toothbrush and intake and output monitored for any abnormalities. Gentle palpation should still be included in physical assessments.

Rationale 2: When the child is thrombocytopenic (decreased platelets) from chemotherapy, the nurse should not administer IM injections because of the risk of bleeding. Oral hygiene care should be done with a soft toothbrush and intake and output monitored for any abnormalities. Gentle palpation should still be included in physical assessments.

Rationale 3: When the child is thrombocytopenic (decreased platelets) from chemotherapy, the nurse should not administer IM injections because of the risk of bleeding. Oral hygiene care should be done with a soft toothbrush and intake and output monitored for any abnormalities. Gentle palpation should still be included in physical assessments.

Rationale 4: When the child is thrombocytopenic (decreased platelets) from chemotherapy, the nurse should not administer IM injections because of the risk of bleeding. Oral hygiene care should be done with a soft toothbrush and intake and output monitored for any abnormalities. Gentle palpation should still be included in physical assessments.

Global Rationale: When the child is thrombocytopenic (decreased platelets) from chemotherapy, the nurse should not administer IM injections because of the risk of bleeding. Oral hygiene care should be done with a soft toothbrush and intake and output monitored for any abnormalities. Gentle palpation should still be included in physical assessments.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO 24.2 Synthesize information about diagnostic tests and clinical therapy for cancer to plan comprehensive care for children undergoing these procedures.

Question 7

Type: SEQ

A child undergoing chemotherapeutic treatment for cancer is being admitted to the hospital for fever of 102 degrees F and possible sepsis. Cultures, antibiotics, and acetaminophen (Tylenol) along with bed rest have been ordered for this child. Place the following steps in order from first to last.

Standard Text: Click on the down arrow for each response in the right column and select the correct choice from the list.

Response 1. Administer the antibiotics.

Response 2. Administer the acetaminophen (Tylenol).

Response 3. Obtain the cultures.

Response 4. Ensure the child has bed rest.

Correct Answer: 2,3,1,4

Rationale 1: Give acetaminophen (Tylenol) first to decrease discomfort and reduce fever. Obtain the cultures next because management of infections is critical, and since a child on chemotherapy has lowered immune status, unusual agents can be identified. Cultures can help identify the causative agents before treatment is started. Give the antibiotics next, as an infection can seriously impact the child who is receiving chemotherapy. Finally, provide comfort followed by bed rest to allow the child to rest.

Rationale 2: Give acetaminophen (Tylenol) first to decrease discomfort and reduce fever. Obtain the cultures next because management of infections is critical, and since a child on chemotherapy has lowered immune status, unusual agents can be identified. Cultures can help identify the causative agents before treatment is started. Give the antibiotics next, as an infection can seriously impact the child who is receiving chemotherapy. Finally, provide comfort followed by bed rest to allow the child to rest.

Rationale 3: Give acetaminophen (Tylenol) first to decrease discomfort and reduce fever. Obtain the cultures next because management of infections is critical, and since a child on chemotherapy has lowered immune status, unusual agents can be identified. Cultures can help identify the causative agents before treatment is started. Give the antibiotics next, as an infection can seriously impact the child who is receiving chemotherapy. Finally, provide comfort followed by bed rest to allow the child to rest.

Rationale 4: Give acetaminophen (Tylenol) first to decrease discomfort and reduce fever. Obtain the cultures next because management of infections is critical, and since a child on chemotherapy has lowered immune status, unusual agents can be identified. Cultures can help identify the causative agents before treatment is started. Give the antibiotics next, as an infection can seriously impact the child who is receiving chemotherapy. Finally, provide comfort followed by bed rest to allow the child to rest.

Global Rationale: 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: LO 24.2 Synthesize information about diagnostic tests and clinical therapy for cancer to plan comprehensive care for children undergoing these procedures.

Question 8

Type: MCSA

A 24-hour urine collection for vanillylmandelic acid (VMA) has been ordered on a child suspected of having neuroblastoma. When is the most appropriate time for the nurse to begin the collection?

1. At 0700

2. After the next time the child voids

3. At bedtime

4. When the order is noted

Correct Answer: 2

Rationale 1: A 24-hour urine collection is started after the child voids. That specimen is not saved, but all subsequent specimens in that 24-hour period should be collected. It would not be an accurate collection of 24 hours of urine if the collection began at 0700, bedtime, or when the order is noted.

Rationale 2: A 24-hour urine collection is started after the child voids. That specimen is not saved, but all subsequent specimens in that 24-hour period should be collected. It would not be an accurate collection of 24 hours of urine if the collection began at 0700, bedtime, or when the order is noted.

Rationale 3: A 24-hour urine collection is started after the child voids. That specimen is not saved, but all subsequent specimens in that 24-hour period should be collected. It would not be an accurate collection of 24 hours of urine if the collection began at 0700, bedtime, or when the order is noted.

Rationale 4: A 24-hour urine collection is started after the child voids. That specimen is not saved, but all subsequent specimens in that 24-hour period should be collected. It would not be an accurate collection of 24 hours of urine if the collection began at 0700, bedtime, or when the order is noted.

Global Rationale: A 24-hour urine collection is started after the child voids. That specimen is not saved, but all subsequent specimens in that 24-hour period should be collected. It would not be an accurate collection of 24 hours of urine if the collection began at 0700, bedtime, or when the order is noted.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: LO 24.4 Recognize the most common solid tumors in children, describe their treatment, and plan comprehensive nursing care.

Question 9

Type: MCSA

A child is diagnosed with a Wilms tumor. Which nursing action is most appropriate prior to surgery?

1. Careful bathing and handling

2. Monitoring of behavioral status

3. Maintenance of strict isolation

4. Administration of packed red-blood cells

Correct Answer: 1

Rationale 1: The tumor should never be palpated; careful bathing and handling are an important nursing consideration. Palpating the tumor can cause a piece of the tumor to dislodge. The childs behavior will not be affected with a Wilms tumor. The tumor does not cause excessive lowering of WBCs or RBCs, so strict isolation or administration of packed red-blood cells is not usually a nursing intervention.

Rationale 2: The tumor should never be palpated; careful bathing and handling are an important nursing consideration. Palpating the tumor can cause a piece of the tumor to dislodge. The childs behavior will not be affected with a Wilms tumor. The tumor does not cause excessive lowering of WBCs or RBCs, so strict isolation or administration of packed red-blood cells is not usually a nursing intervention.

Rationale 3: The tumor should never be palpated; careful bathing and handling are an important nursing consideration. Palpating the tumor can cause a piece of the tumor to dislodge. The childs behavior will not be affected with a Wilms tumor. The tumor does not cause excessive lowering of WBCs or RBCs, so strict isolation or administration of packed red-blood cells is not usually a nursing intervention.

Rationale 4: The tumor should never be palpated; careful bathing and handling are an important nursing consideration. Palpating the tumor can cause a piece of the tumor to dislodge. The childs behavior will not be affected with a Wilms tumor. The tumor does not cause excessive lowering of WBCs or RBCs, so strict isolation or administration of packed red-blood cells is not usually a nursing intervention.

Global Rationale: The tumor should never be palpated; careful bathing and handling are an important nursing consideration. Palpating the tumor can cause a piece of the tumor to dislodge. The childs behavior will not be affected with a Wilms tumor. The tumor does not cause excessive lowering of WBCs or RBCs, so strict isolation or administration of packed red-blood cells is not usually a nursing intervention.

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Safety and Infection Control

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: LO 24.4 Recognize the most common solid tumors in children, describe their treatment, and plan comprehensive nursing care.

Question 10

Type: MCSA

An adolescent is receiving methotrexate chemotherapy after undergoing limb-salvage surgery for osteogenic sarcoma. Which statement by the adolescent indicates understanding of the purpose of leucovorin therapy after the methotrexate?

1. Im glad I only need one dose of the leucovorin.

2. I dont have any pain so I wont need to take the leucovorin this time.

3. I know I will be taking the leucovorin every 6 hours for about the next 3 days.

4. I dont have any nausea so I wont need the leucovorin.

Correct Answer: 3

Rationale 1: 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 for 72 hours or until serum methotrexate is at the desired level.

Rationale 2: 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 for 72 hours or until serum methotrexate is at the desired level.

Rationale 3: 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 for 72 hours or until serum methotrexate is at the desired level.

Rationale 4: 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 for 72 hours or until serum methotrexate is at the desired level.

Global Rationale: 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 for 72 hours or until serum methotrexate is at the desired level.

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: LO 24.4 Recognize the most common solid tumors in children, describe their treatment, and plan comprehensive nursing care.

Question 11

Type: MCSA

A child who is diagnosed with leukemia has a sibling who is expressing feelings of anger and guilt. How would the nurse characterize this reaction by the sibling?

1. Abnormal; the sibling should be referred to a psychologist.

2. Normal; the illness doesnt affect the sibling.

3. Unexpected; the cancer is easily treated.

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

Correct Answer: 4

Rationale 1: A diagnosis of cancer affects the whole family, and initial feelings experienced by the sibling may be anger and guilt. Seldom will the sibling be unaffected; however, the response is not abnormal.

Rationale 2: A diagnosis of cancer affects the whole family, and initial feelings experienced by the sibling may be anger and guilt. Seldom will the sibling be unaffected; however, the response is not abnormal.

Rationale 3: A diagnosis of cancer affects the whole family, and initial feelings experienced by the sibling may be anger and guilt. Seldom will the sibling be unaffected; however, the response is not abnormal.

Rationale 4: A diagnosis of cancer affects the whole family, and initial feelings experienced by the sibling may be anger and guilt. Seldom will the sibling be unaffected; however, the response is not abnormal.

Global Rationale: A diagnosis of cancer affects the whole family, and initial feelings experienced by the sibling may be anger and guilt. Seldom will the sibling be unaffected; however, the response is not abnormal.

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub: 

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO 24.5 Plan care for children and adolescents of all ages who have a diagnosis of leukemia.

Question 12

Type: MCSA

The child is admitted to the hospital after being diagnosed with retinoblastoma. Which assessment finding does the nurse anticipate for this child?

1. A red reflex

2. Yellow sclera

3. A white pupil

4. Blue-tinged sclera

Correct Answer: 3

Rationale 1: The first sign of retinoblastoma is a white pupil. The red reflex is absent. Yellow sclera is a sign of jaundice, not retinoblastoma. Blue-tinged sclera is a sign of osteogenesis imperfecta, not retinoblastoma.

Rationale 2: The first sign of retinoblastoma is a white pupil. The red reflex is absent. Yellow sclera is a sign of jaundice, not retinoblastoma. Blue-tinged sclera is a sign of osteogenesis imperfecta, not retinoblastoma.

Rationale 3: The first sign of retinoblastoma is a white pupil. The red reflex is absent. Yellow sclera is a sign of jaundice, not retinoblastoma. Blue-tinged sclera is a sign of osteogenesis imperfecta, not retinoblastoma.

Rationale 4: The first sign of retinoblastoma is a white pupil. The red reflex is absent. Yellow sclera is a sign of jaundice, not retinoblastoma. Blue-tinged sclera is a sign of osteogenesis imperfecta, not retinoblastoma.

Global Rationale: first sign of retinoblastoma is a white pupil. The red reflex is absent. Yellow sclera is a sign of jaundice, not retinoblastoma. Blue-tinged sclera is a sign of osteogenesis imperfecta, not retinoblastoma.

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO 24.4 Recognize the most common solid tumors in children, describe their treatment, and plan comprehensive nursing care.

Question 13

Type: MCSA

A preschool-age child is brought to the clinic by the mother, who says the child has been lethargic and anorexic lately and complains of bone pain. On exam, the nurse notes petechiae, joint pain, and an enlarged liver. Which diagnosis does the nurse anticipate for this child?

1. Hodgkin disease

2. Leukemia

3. Rhabdomyosarcoma

4. Ewing sarcoma

Correct Answer: 2

Rationale 1: Hodgkin disease, rhabdomyosarcoma, and Ewing sarcoma are all childhood cancers, but they do not have the clinical manifestations listed. Leukemia is one of the most common childhood cancers, and has those clinical symptoms.

Rationale 2: Hodgkin disease, rhabdomyosarcoma, and Ewing sarcoma are all childhood cancers, but they do not have the clinical manifestations listed. Leukemia is one of the most common childhood cancers, and has those clinical symptoms.

Rationale 3: Hodgkin disease, rhabdomyosarcoma, and Ewing sarcoma are all childhood cancers, but they do not have the clinical manifestations listed. Leukemia is one of the most common childhood cancers, and has those clinical symptoms.

Rationale 4: Hodgkin disease, rhabdomyosarcoma, and Ewing sarcoma are all childhood cancers, but they do not have the clinical manifestations listed. Leukemia is one of the most common childhood cancers, and has those clinical symptoms.

Global Rationale: Hodgkin disease, rhabdomyosarcoma, and Ewing sarcoma are all childhood cancers, but they do not have the clinical manifestations listed. Leukemia is one of the most common childhood cancers, and has those clinical symptoms.

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO 24.5 Plan care for children and adolescents of all ages who have a diagnosis of leukemia.

Question 14

Type: MCSA

A child with a brain tumor is admitted to the pediatric intensive care unit (PICU)after brain surgery to remove the tumor. Which postoperative order would the nurse question?

1. Antibiotics

2. Sodium levels every 24 hours

3. Anticonvulsants

4. Hourly intake and output

Correct Answer: 2

Rationale 1: Antibiotics, anticonvulsants, and hourly intake and output are appropriate orders. Serum sodium levels should be done every 46 hours, not every 24 hours.

Rationale 2: Antibiotics, anticonvulsants, and hourly intake and output are appropriate orders. Serum sodium levels should be done every 46 hours, not every 24 hours.

Rationale 3: Antibiotics, anticonvulsants, and hourly intake and output are appropriate orders. Serum sodium levels should be done every 46 hours, not every 24 hours.

Rationale 4: Antibiotics, anticonvulsants, and hourly intake and output are appropriate orders. Serum sodium levels should be done every 46 hours, not every 24 hours.

Global Rationale: Antibiotics, anticonvulsants, and hourly intake and output are appropriate orders. Serum sodium levels should be done every 46 hours, not every 24 hours.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO 24.4 Recognize the most common solid tumors in children, describe their treatment, and plan comprehensive nursing care.

Question 15

Type: MCSA

A child is diagnosed with rhabdomyosarcoma. Which nursing intervention is most appropriate for this child?

1. Position the child with the head elevated.

2. Monitor for hematuria.

3. Demonstrate the use of a conformer.

4. Administer oxygen.

Correct Answer: 1

Rationale 1: The most common area of the body affected by rhabdomyosarcoma is the bladder. The nursing intervention that is most appropriate is to monitor the childs urine for hematuria. Positioning the child with the head elevated and administering oxygen is appropriate for a child diagnosed with lymphoma. Demonstrating the use of a conformer is appropriate for a child diagnosed with retinoblastoma.

Rationale 2: The most common area of the body affected by rhabdomyosarcoma is the bladder. The nursing intervention that is most appropriate is to monitor the childs urine for hematuria. Positioning the child with the head elevated and administering oxygen is appropriate for a child diagnosed with lymphoma. Demonstrating the use of a conformer is appropriate for a child diagnosed with retinoblastoma.

Rationale 3: The most common area of the body affected by rhabdomyosarcoma is the bladder. The nursing intervention that is most appropriate is to monitor the childs urine for hematuria. Positioning the child with the head elevated and administering oxygen is appropriate for a child diagnosed with lymphoma. Demonstrating the use of a conformer is appropriate for a child diagnosed with retinoblastoma.

Rationale 4: The most common area of the body affected by rhabdomyosarcoma is the bladder. The nursing intervention that is most appropriate is to monitor the childs urine for hematuria. Positioning the child with the head elevated and administering oxygen is appropriate for a child diagnosed with lymphoma. Demonstrating the use of a conformer is appropriate for a child diagnosed with retinoblastoma.

Global Rationale: The most common area of the body affected by rhabdomyosarcoma is the bladder. The nursing intervention that is most appropriate is to monitor the childs urine for hematuria. Positioning the child with the head elevated and administering oxygen is appropriate for a child diagnosed with lymphoma. Demonstrating the use of a conformer is appropriate for a child diagnosed with retinoblastoma.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO 24.6 Prioritize elements of comprehensive care planning for children with soft-tissue tumors.

Question 16

Type: MCMA

The pediatric nurse educator is conducting an in-service for novice nurses who will begin working on the pediatric oncology unit. The educator wants to include the common clinical manifestations of cancer. Which manifestation will the educator include in the presentation?

Standard Text: Select all that apply.

1. Cachexia

2. Anemia

3. Gene abnormalities

4. Palpable mass

5. Chromosomal abnormalities

Correct Answer: 1,2,4

Rationale 1: Common clinical manifestations of childhood cancer include cachexia, anemia, and a palpable mass. Gene abnormalities and chromosomal abnormalities are common etiologies to childhood cancer, not clinical manifestations.

Rationale 2: Common clinical manifestations of childhood cancer include cachexia, anemia, and a palpable mass. Gene abnormalities and chromosomal abnormalities are common etiologies to childhood cancer, not clinical manifestations.

Rationale 3: Common clinical manifestations of childhood cancer include cachexia, anemia, and a palpable mass. Gene abnormalities and chromosomal abnormalities are common etiologies to childhood cancer, not clinical manifestations.

Rationale 4: Common clinical manifestations of childhood cancer include cachexia, anemia, and a palpable mass. Gene abnormalities and chromosomal abnormalities are common etiologies to childhood cancer, not clinical manifestations.

Rationale 5: Common clinical manifestations of childhood cancer include cachexia, anemia, and a palpable mass. Gene abnormalities and chromosomal abnormalities are common etiologies to childhood cancer, not clinical manifestations.

Global Rationale: Common clinical manifestations of childhood cancer include cachexia, anemia, and a palpable mass. Gene abnormalities and chromosomal abnormalities are common etiologies to childhood cancer, not clinical manifestations.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO 24.1 Describe the incidence, known etiologies, and common clinical manifestations of cancer.

Question 17

Type: MCMA

The pediatric nurse is providing care to a school-age child receiving chemotherapy to treat cancer. Which interventions are appropriate to include in the plan of care in order to monitor for oncologic emergencies?

Standard Text: Select all that apply.

1. Monitor complete blood count (CBC).

2. Document intake and output.

3. Observe for behavioral changes.

4. Refer for psychosocial support.

5. Implement neutropenic precautions.

Correct Answer: 1,2,3

Rationale 1: Oncologic emergencies can be organized into three groups: metabolic, hematologic, and those involving space-occupying lesions. Appropriate interventions for the nurse to include in the plan of care to monitor for these emergencies include monitoring the CBC to prevent sepsis and hemorrhage; monitoring intake and output by encouraging hydration to prevent hypercalcemia and observing for signs of water intoxication; and observing for behavioral changes as space-occupying lesions may cause seizures or increased intracranial pressure. Referring for psychosocial support and implementing neutropenia precautions may be appropriate, but these interventions do not address oncologic emergencies.

Rationale 2: Oncologic emergencies can be organized into three groups: metabolic, hematologic, and those involving space-occupying lesions. Appropriate interventions for the nurse to include in the plan of care to monitor for these emergencies include monitoring the CBC to prevent sepsis and hemorrhage; monitoring intake and output by encouraging hydration to prevent hypercalcemia and observing for signs of water intoxication; and observing for behavioral changes as space-occupying lesions may cause seizures or increased intracranial pressure. Referring for psychosocial support and implementing neutropenia precautions may be appropriate, but these interventions do not address oncologic emergencies.

Rationale 3: Oncologic emergencies can be organized into three groups: metabolic, hematologic, and those involving space-occupying lesions. Appropriate interventions for the nurse to include in the plan of care to monitor for these emergencies include monitoring the CBC to prevent sepsis and hemorrhage; monitoring intake and output by encouraging hydration to prevent hypercalcemia and observing for signs of water intoxication; and observing for behavioral changes as space-occupying lesions may cause seizures or increased intracranial pressure. Referring for psychosocial support and implementing neutropenia precautions may be appropriate, but these interventions do not address oncologic emergencies.

Rationale 4: Oncologic emergencies can be organized into three groups: metabolic, hematologic, and those involving space-occupying lesions. Appropriate interventions for the nurse to include in the plan of care to monitor for these emergencies include monitoring the CBC to prevent sepsis and hemorrhage; monitoring intake and output by encouraging hydration to prevent hypercalcemia and observing for signs of water intoxication; and observing for behavioral changes as space-occupying lesions may cause seizures or increased intracranial pressure. Referring for psychosocial support and implementing neutropenia precautions may be appropriate, but these interventions do not address oncologic emergencies.

Rationale 5: Oncologic emergencies can be organized into three groups: metabolic, hematologic, and those involving space-occupying lesions. Appropriate interventions for the nurse to include in the plan of care to monitor for these emergencies include monitoring the CBC to prevent sepsis and hemorrhage; monitoring intake and output by encouraging hydration to prevent hypercalcemia and observing for signs of water intoxication; and observing for behavioral changes as space-occupying lesions may cause seizures or increased intracranial pressure. Referring for psychosocial support and implementing neutropenia precautions may be appropriate, but these interventions do not address oncologic emergencies.

 

Global Rationale: Oncologic emergencies can be organized into three groups: metabolic, hematologic, and those involving space-occupying lesions. Appropriate interventions for the nurse to include in the plan of care to monitor for these emergencies include monitoring the CBC to prevent sepsis and hemorrhage; monitoring intake and output by encouraging hydration to prevent hypercalcemia and observing for signs of water intoxication; and observing for behavioral changes as space-occupying lesions may cause seizures or increased intracranial pressure. Referring for psychosocial support and implementing neutropenia precautions may be appropriate, but these interventions do not address oncologic emergencies.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: LO 24.3 Integrate information about oncologic emergencies into plans for monitoring all children with cancer.

Question 18

Type: MCMA

A seasoned nurse is precepting a novice nurse on a pediatric oncology unit. The seasoned nurse would like to review the ongoing physiologic and psychosocial care of the children who survive cancer. Which topics will the seasoned nurse include in the discussion with the novice nurse?

Standard Text: Select all that apply.

1. Developing other cancers

2. Recommending regular office visits

3. Encouraging school-age clients to manage their own care

4. Needing weekly laboratory tests

5. Providing educational and psychosocial support

Correct Answer: 1,2,5

Rationale 1: Appropriate topics include discussing the increased risk for these children to develop other cancers; recommending regular office visits for monitoring purposes; and providing educational and psychosocial support.  It would be appropriate to encourage the adolescent and young adult clients to manage their own care, not a school-age child. While these clients need regular laboratory examinations, weekly laboratory tests are not appropriate.

Rationale 2: Appropriate topics include discussing the increased risk for these children to develop other cancers; recommending regular office visits for monitoring purposes; and providing educational and psychosocial support.  It would be appropriate to encourage the adolescent and young adult clients to manage their own care, not a school-age child. While these clients need regular laboratory examinations, weekly laboratory tests are not appropriate.

Rationale 3: Appropriate topics include discussing the increased risk for these children to develop other cancers; recommending regular office visits for monitoring purposes; and providing educational and psychosocial support.  It would be appropriate to encourage the adolescent and young adult clients to manage their own care, not a school-age child. While these clients need regular laboratory examinations, weekly laboratory tests are not appropriate.

Rationale 4: Appropriate topics include discussing the increased risk for these children to develop other cancers; recommending regular office visits for monitoring purposes; and providing educational and psychosocial support.  It would be appropriate to encourage the adolescent and young adult clients to manage their own care, not a school-age child. While these clients need regular laboratory examinations, weekly laboratory tests are not appropriate.

Rationale 5: Appropriate topics include discussing the increased risk for these children to develop other cancers; recommending regular office visits for monitoring purposes; and providing educational and psychosocial support.  It would be appropriate to encourage the adolescent and young adult clients to manage their own care, not a school-age child. While these clients need regular laboratory examinations, weekly laboratory tests are not appropriate.

Global Rationale: Appropriate topics include discussing the increased risk for these children to develop other cancers; recommending regular office visits for monitoring purposes; and providing educational and psychosocial support.  It would be appropriate to encourage the adolescent and young adult clients to manage their own care, not a school-age child. While these clients need regular laboratory examinations, weekly laboratory tests are not appropriate.

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub: 

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: LO 24.7 Analyze the impact of cancer survival on children and use this information to plan for ongoing physiologic and psychosocial care in the childrens futures.

Ball/Bindler/Cowen, Principles of Pediatric Nursing 6th Ed. Test Bank

Copyright 2015 by Pearson Education, Inc.

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