CHAPTER 29: CELLULAR ALTERATIONS My Nursing Test Banks

CHAPTER 29: CELLULAR ALTERATIONS

MULTIPLE CHOICE

1.Which of the following is the most common childhood malignancy?

a.

lymphoma

c.

Wilms tumor

b.

leukemia

d.

neuroblastoma

ANS: B

Feedback

A

Incorrect. Lymphoma is second to leukemia.

B

Correct. The most common childhood malignancy is leukemia, followed by lymphoma, Wilms tumor, and neuroblastoma.

C

Incorrect. Wilms tumor is third behind leukemia and lymphoma.

D

Incorrect. Neuroblastoma is fourth behind leukemia, lymphoma and Wilms tumor.

PTS:1REF:p. 1024 Treatment Modalities

OBJ: Cognitive Level: Comprehension

2.Which of the following is the leading cause of death from disease in children 1 to 14 years of age?

a.

cancer

c.

diabetes

b.

heart disease

d.

cerebral palsy

ANS: A

Feedback

A

Correct. Although rare in children, cancer is the leading cause of death from disease in children ages 1 to 14 years.

B

Incorrect. Heart disease is not a leading cause of death from disease in children.

C

Incorrect. Diabetes is not a leading cause of death from disease in children.

D

Incorrect. Cerebral palsy is not a leading cause of death from disease in children.

PTS:1REF:p. 1024 Treatment Modalities

OBJ: Cognitive Level: Comprehension

3.Which of the following statements comparing childhood cancer with adult cancer is true?

a.

There is no difference in childhood cancer and adult cancer.

b.

Childhood cancers usually arise from primitive embryonic tissue and adult malignancies are of epithelial origin.

c.

Routine screens catch childhood cancers more often than adult cancers.

d.

Exposure to carcinogens is related in a stronger way to childhood cancers than to adult cancers.

ANS: B

Feedback

A

Incorrect. Differences between childhood cancer and adult cancer do exist.

B

Correct. In contrast to adult malignancies, which arise from epithelial origin, childhood malignancies typically arise from primitive embryonic tissue.

C

Incorrect. Routine exams are not identified as finding cancers more frequently in children than in adults.

D

Incorrect. Carcinogens are not related to childhood cancers more than adult cancers, as children have not lived long enough for carcinogens to cause a malignancy.

PTS:1REF:p. 1024 Treatment Modalities

OBJ: Cognitive Level: Application

4.What is the cure rate for childhood cancers?

a.

less than 20%

c.

50%

b.

40%

d.

greater than 70%

ANS: D

Feedback

A

Incorrect. The cure rate for childhood cancers is greater than 70%, not less than 20%.

B

Incorrect. The cure rate for childhood cancers is greater than 70%, not 40%.

C

Incorrect. The cure rate for childhood cancers is greater than 70%, not 50%.

D

Correct. With greater than 70% of children diagnosed with cancer surviving, childhood cancer has become a curable disease.

PTS:1REF:p. 1024 Treatment Modalities

OBJ: Cognitive Level: Comprehension

5.Which of the following methods provides an organized, coordinated approach to cancer treatment?

a.

Internet groups providing information on nontraditional treatment programs out of the country

b.

survivors group comparing information and disseminating it to others with cancer

c.

the use of clinical trials and the resultant data to improve therapy and increase survival

d.

specialized hospitals and cancer specialists providing training workshops

ANS: C

Feedback

A

Incorrect. Internet groups, survivors group comparisons, and workshops are not effective methodologies for providing an organized, coordinated approach to cancer treatment.

B

Incorrect. Internet groups, survivors group comparisons, and workshops are not effective methodologies for providing an organized, coordinated approach to cancer treatment.

C

Correct. The use of clinical trials and their resultant data have provided health care practitioners with an organized, coordinated approach to cancer treatment. Clinical trials evolve into protocols or guidelines for use then treating a specific disease.

D

Incorrect. Internet groups, survivors group comparisons, and workshops are not effective methodologies for providing an organized, coordinated approach to cancer treatment.

PTS:1REF:p. 1024 Treatment Modalities

OBJ: Cognitive Level: Comprehension

6.The nurse is working with a client who has cancer that has been staged as a stage I. The nurse realizes that this cancer is best described as:

a.

a cancer with disseminated metastatic disease

b.

cancer with a certainty of being fatal

c.

a localized disease in just one area or organ

d.

the end stage of cancer

ANS: C

Feedback

A

Incorrect. Disseminated metastatic disease is suggestive of stage IV.

B

Incorrect. Because the cancer is localized, it is not certain to be fatal, nor is it considered to be the end stage of cancer.

C

Correct. For a client with cancer identified as stage I, the nurse is aware that the cancer is a localized disease in just one area or organ.

D

Incorrect. Because the cancer is localized, it is not certain to be fatal, nor is it considered to be the end stage of cancer.

PTS:1REF:p. 1025 Treatment Modalities

OBJ: Cognitive Level: Application

7.Which of the following treatments is the most frequently used in pediatric oncology?

a.

surgery

c.

chemotherapy

b.

radiation

d.

radioactive materials

ANS: C

Feedback

A

Incorrect. In this population, chemotherapy is effective in treating systemic cancers that cannot be managed by surgery.

B

Incorrect. In this population, chemotherapy is effective in treating systemic cancers that cannot be managed by radiation therapy.

C

Correct. For the pediatric oncology client, the most frequently used treatment modality is chemotherapy.

D

Incorrect. Radioactive materials are not frequently used in pediatric oncology.

PTS:1REF:p. 1026 Treatment Modalities

OBJ: Cognitive Level: Comprehension

8.The nurse hears the word nadir in a shift report in connection with a childs blood counts. The nurse is aware that nadir refers to which of the following concepts?

a.

the point at which the child has reached a normal blood cell count and is on the road to recovery

b.

the lowest point in the childs blood counts or myelosuppression, which occurs about 10 to 14 days after chemotherapy

c.

the point at which the child has been free of cancer symptoms for 5 years and has more likely beaten cancer

d.

a safe level of blood cell counts representing neither a high or a low in cell counts

ANS: B

Feedback

A

Incorrect. The nadir would not used to describe the point at which a normal blood cell count has been achieved.

B

Correct. Occurring 10 to 14 days after most chemotherapy is administered, the nadir represents the lowest point in the clients blood counts or myelosuppression.

C

Incorrect. The nadir would not used to describe the point at which the child has been free of cancer symptoms for 5 years.

D

Incorrect. The nadir is not described as a safe level of blood cell counts representing neither a high or low cell count.

PTS:1REF:p. 1026 Treatment Modalities

OBJ: Cognitive Level: Application

9.The nurse is assigned to a child who has a platelet count of 15,000 per cubic millimeter. The nurse realizes that which of the following is true?

a.

A blood thinner such as Coumadin needs to be considered by the physician.

b.

There is a serious danger of infection even from normal skin bacteria.

c.

This is a normal platelet count, and there is nothing to worry about in regard to platelets.

d.

The child has a high risk of spontaneous bleeding, which can be life threatening.

ANS: D

Feedback

A

Incorrect. The addition of an anticoagulant would not be an appropriate intervention, as such medications would place the client at greater risk of bleeding.

B

Incorrect. The platelet count is not indicative of signs and symptoms of infection.

C

Incorrect. A platelet count of 15,000 is not considered a normal finding.

D

Correct. A platelet count of less than 20,000 places the child at a high risk of spontaneous bleeding, a potentially life-threatening condition.

PTS:1REF:p. 1026 Treatment Modalities

OBJ: Cognitive Level: Application

10.When a child has thrombocytopenia, the nurse must do which of the following in regard to any intramuscular (IM) injections or venipunctures ordered?

a.

Administer any IM or intravenous (IV) medication very slowly to avoid problems.

b.

Apply pressure to the site for 10 minutes after administration.

c.

Apply ice to any IM or IV site for 15 minutes each hour.

d.

Avoid aspirating after injection, and avoid massaging the site.

ANS: B

Feedback

A

Incorrect. The slow administration of IM and IV medications is not identified as being a necessary intervention.

B

Correct. Thrombocytopenia, which results from a decrease in the number of platelets, places the pediatric client at risk for bleeding. Therefore, it will be necessary for the nurse to apply pressure to the injection site for at least 10 minutes following the administration of the medication.

C

Incorrect. Ice would not be necessary to the IM or IV site.

D

Incorrect. Massaging the site would be contraindicated, as doing so may promote bleeding at the site.

PTS:1REF:p. 1026 Treatment Modalities

OBJ: Cognitive Level: Application

11.When the nurse is working with a child who has a low platelet count, the nurse will teach the family and the child to avoid which of the following?

a.

engaging in contact sports or any activity that has a risk of physical injury

b.

taking daily vitamins with mineral supplements or zinc supplements

c.

herbal teas of any type

d.

leaving the house for any reason

ANS: A

Feedback

A

Correct. For a child who has a low platelet count, the family and child should be taught to be protected from trauma. Prevention measures include avoiding playing or engaging in contact sports or any activity that has a risk of physical injury.

B

Incorrect. Taking daily vitamins with mineral supplements or zinc supplements will not protect the child with a low platelet count from bleeding.

C

Incorrect. Herbal teas of any type will not protect the child with a low platelet count from bleeding.

D

Incorrect. The child can leave the house. He or she just needs to be protected from trauma.

PTS:1REF:p. 1026 Treatment Modalities

OBJ: Cognitive Level: Application

12.The nurse working with a child in the pediatric unit gets a lab report back on the child, which shows an absolute neutrophil count (ANC) of slightly less than 500 per cubic millimeter. This ANC tells the nurse which of the following things?

a.

The neutrophil count is approaching normal and the child is on the way to recovery.

b.

Even normal body flora can put the child at risk for serious life-threatening bacterial infections.

c.

Vital signs need to be taken at least every two hours with all temperatures taken rectally.

d.

The child needs an iron-rich diet and needs to add more fresh fruits and vegetables to the diet.

ANS: B

Feedback

A

Incorrect. This neutrophil count is not approaching normal and the child is not on the way to recovery. A normal ANC is > 1000 per cubic mm.

B

Correct. A child with an ANC of 500 or less per cubic moms at risk for serious life-threatening bacterial infections, which are usually caused by normal body flora.

C

Incorrect. The temperature of a child who is neutropenic should be monitored closely because infection in this child can quickly progress to septic shock and death. However, rectal temperatures should be avoided because it could lead to a break in the rectal mucosa, allowing bacteria into the bloodstream.

D

Incorrect. The child who is neutropenic is immunosuppressed, and an iron-rich diet and more fresh fruits and vegetables will not resolve the problem.

PTS:1REF:p. 1035 Cellular Alterations

OBJ: Cognitive Level: Application

13.Which of the following signs or symptoms will the nurse find on assessing a child who is neutropenic and has an infection?

a.

elevated temperature and complaint of a feverish feeling

b.

production of pus

c.

redness of inflammation

d.

no signs except perhaps complaint of pain or swelling

ANS: D

Feedback

A

Incorrect. The child may have an elevated temperature but will have no complaints of a feverish feeling.

B

Incorrect. There will be no production of pus.

C

Incorrect. There will be no redness of inflammation.

D

Correct. A child who is neutropenic and has an infection will not mount an immune response to infection. There will not be the usual inflammatory response to the infection such as redness or production of pus because of the lack of neutrophils. She or he may complain of pain or swelling. Fever may be the only sign of infection.

PTS:1REF:p. 1035 Treatment Modalities

OBJ: Cognitive Level: Application

14.The nurse is working with a child who is immunosuppressed. The parents call to tell the nurse that the child has been exposed to varicella. Which of the following courses of action will the nurse suggest?

a.

Call the pediatrician, and get the child prompt treatment with a varicella immune globulin within 72 hours of exposure.

b.

Isolate the child, and get an order for an immunization for varicella if the child has not received the immunization.

c.

Take the child to the emergency room there the doctor will begin intravenous (IV) antibiotics.

d.

Take the child to the doctors office to be seen by the nurse practitioner or the pediatrician.

ANS: A

Feedback

A

Correct. If a child who is immunosuppressed is exposed to varicella, the parents need to call the pediatrician, and get the child prompt treatment with a varicella immune globulin within 72 hours of exposure as a preventive measure. Varicella can be an overwhelming infection in this child.

B

Incorrect. The parents should not isolate the child, and get an order for an immunization for varicella if the child has not received the immunization. Prompt treatment with varicella immune globulin is needed.

C

Incorrect. The parents may take the child to the emergency room if directed so by their pediatrician. However, IV antibiotics will not be given.

D

Incorrect. The parents should not take the child to the doctors office to be seen by the nurse practitioner or the pediatrician.

PTS:1REF:p. 1035 Treatment Modalities

OBJ: Cognitive Level: Application

15.The nurse is working with an immunosuppressed child. A parent points out that the child is due to have oral poliovirus vaccine and a measles-mumps-rubella (MMR) vaccine prior to school starting. The nurse will advise the parent to do which of the following?

a.

Have the child get the MMR but not the oral poliovirus.

b.

Take the child to get the oral poliovirus vaccine but not the MMR.

c.

Omit live viral vaccines until the child is no longer immunosuppressed.

d.

Talk with the pediatrician about getting gamma globulin with the vaccines.

ANS: C

Feedback

A

Incorrect. The nurse will not advise the parent to have the child get the MMR but not the oral poliovirus. Neither should be given.

B

Incorrect. The nurse will not advise the parent to take the child to get the oral poliovirus vaccine but not the MMR. Neither should be given.

C

Correct. The nurse will advise the parent to omit live viral vaccines until the child is no longer immunosuppressed. The child is at risk for developing the disease if a live vaccine is given. MMR and oral poliovirus vaccine are live vaccines.

D

Incorrect. The nurse will not advise the parent to talk with the pediatrician about getting gamma globulin with the vaccines. Neither vaccine should be given.

PTS:1REF:p. 1036 Treatment Modalities

OBJ: Cognitive Level: Application

16.The nurse assessing a child who is undergoing chemotherapy finds the child to be suffering from mucositis. Which of the following interventions would be most helpful?

a.

good oral care to clean the oral cavity of food particles and debris

b.

sips of ice and lubricating oil to the lips

c.

a room humidifier with a eucalyptus oil added to the water

d.

six to eight glasses of water every day

ANS: A

Feedback

A

Correct. Good oral care including use of a cleansing solution such as warm water or chlorhexidine to clean the oral cavity of food particles and debris would be most helpful for treating mucositis. Mucositis (stomatitis) is a common gastrointestinal side effect of chemotherapy. It is an inflammation of the oral mucosa that ranges from mild redness to severe, painful ulceration which may cause a decrease in oral intake and lead to dehydration, poor nutrition, and weight loss.

B

Incorrect. Sips of ice and lubricating oil to the lips would not be most helpful since the oral ulcers occur in the mouth and pharynx. Similar lesions can extend along the esophagus and in the rectal area.

C

Incorrect. A room humidifier with eucalyptus oil added to the water would not help in treating mucositis.

D

Incorrect. Six to eight glasses of water every day would not help because the mouth ulcers may be too painful for the child to want to drink this amount of fluids.

PTS:1REF:p. 1043 Treatment Modalities

OBJ: Cognitive Level: Application

17.A parent shares with the nurse that his child who is undergoing chemotherapy vomited on the way to the hospital and in the entrance to the outpatient clinic. The nurse will do which of the following things?

a.

Cancel the chemotherapy for the day and reschedule it for another day.

b.

Use interventions such as antiemetics ordered by the physician, relaxation, biofeedback, music, and distraction.

c.

Talk to the physician about ordering a lower dose of chemotherapy or a less-frequent-dosage schedule.

d.

Isolate the child for the next 48 hours to see what is causing the nausea and vomiting.

ANS: B

Feedback

A

Incorrect. The nurse will not cancel the chemotherapy for the day and reschedule it for another day.

B

Correct. The nurse will use interventions such as antiemetics ordered by the physician, and nonpharmacologic interventions such as relaxation, biofeedback, music, and distraction. The most beneficial regimen for antiemetic control has been the administration of the antiemetic 30 minutes to 1 hour before chemotherapy begins and regular administration every 2, 4, or 6 hours for at least 24 hours after chemotherapy.

C

Incorrect. The nurse will not talk to the physician about ordering a lower dose of chemotherapy or a less-frequent-dosage schedule.

D

Incorrect. The nurse will not isolate the child for the next 48 hours to see what is causing the nausea and vomiting. The nausea and vomiting are obviously due to the chemotherapy.

PTS:1REF:p. 1043 Treatment Modalities

OBJ: Cognitive Level: Application

18.A caregiver for a child who is undergoing chemotherapy for cancer shares with the nurse that the childs temperature is being taken rectally every 4 hours. Which of the following is the nurses best response?

a.

Good for you for paying close attention to whether your child has a fever or not.

b.

Once a day, at the same time each day, is the best practice for taking the temperature.

c.

It is not necessary to take the temperature so often. You need only take the childs temperature if you suspect fever.

d.

Stop this practice, because the thermometer can cause breaks in the rectal mucosa and cause bacteria to enter the bloodstream, resulting in sepsis or abscess.

ANS: D

Feedback

A

Incorrect. The nurse might praise the caregiver for paying close attention to whether the child has a fever, but this is not the best response since it does not address the issue of rectal temperatures.

B

Incorrect. This is not the best response since it does not address the issue of rectal temperatures. Additionally, the temperature for a child undergoing chemotherapy should be monitored closely. Once a day is not often enough.

C

Incorrect. This is not the best response since it does not address the issue of rectal temperatures. Additionally, the temperature for a child undergoing chemotherapy should be monitored closely. Taking it only if the caregiver suspects a fever is not often enough.

D

Correct. The nurses best response is to advise the caregiver to not allow rectal temperatures to be taken. Rectal temperatures, rectal medications or performing a rectal exam should be avoided because they could lead to a break in the rectal mucosa, allowing bacteria into the bloodstream. This could result in sepsis, a rectal abscess, or bleeding.

PTS:1REF:p. 1026 Treatment Modalities

OBJ: Cognitive Level: Application

19.The nurse is caring for a child who is receiving chemotherapeutic agents. Prior to administering the chemotherapy, the nurse must check which of the following and report to the physician if the results are high?

a.

cardiac enzymes

b.

hemoglobin and oxygen saturation levels

c.

thyroxine

d.

liver transaminase and bilirubin levels

ANS: D

Feedback

A

Incorrect. Some chemotherapy drugs can cause ECG changes and rapidly progressive heart failure. The heart would be monitored with ECG and cardiac ejection fractions. Cardiac enzymes are measured to diagnose myocardial injury.

B

Incorrect. The nurse might be concerned if hemoglobin and oxygen saturation levels were slightly low, not high.

C

Incorrect. Thyroxine or T4 is not affected by chemotherapy.

D

Correct. Prior to administering the chemotherapy, the nurse must check liver transaminase and bilirubin levels and report to the physician if the results are high. Liver toxicity seen with some chemotherapeutic agents ranges from elevation of hepatic enzymes to liver fibrosis and liver damage caused by long term use of these drugs. High transaminase and bilirubin levels may require a dose reduction or postponement of the agents.

PTS:1REF:p. 1036 Treatment Modalities

OBJ: Cognitive Level: Application

20.When the nurse is working with children receiving Cytoxan or ifosfamide, the nurse is aware that these children are at risk for which of the following conditions?

a.

hemorrhagic cystitis during drug administration or months after administration

b.

pancreatic cancer

c.

severe hearing loss or complete deafness within weeks of receiving these drugs

d.

retrolental fibroplasia

ANS: A

Feedback

A

Correct. Children receiving Cytoxan or ifosfamide are at risk for hemorrhagic cystitis during drug administration or months after administration.

B

Incorrect. Children receiving Cytoxan or ifosfamide are not at risk for pancreatic cancer.

C

Incorrect. Children receiving Cytoxan or ifosfamide are not at risk for severe hearing loss or complete deafness within weeks of receiving these drugs.

D

Incorrect. Children receiving Cytoxan or ifosfamide are not at risk for retrolental fibroplasia.

PTS:1REF:p. 1036 Treatment Modalities

OBJ: Cognitive Level: Application

21.A child who is undergoing chemotherapy will ask the nurse if her hair will fall out. Which of the following is the nurses best response?

a.

Not all children lose their hair, and you may be one of the lucky ones and not lose your hair at all.

b.

Try not to think about your hair. Lets do something to keep your mind off losing your hair.

c.

The hair will probably fall out in 2 weeks or less, but it will grow back then chemotherapy is complete.

d.

Let me get you some crayons, and you can draw your feelings about losing your hair.

ANS: C

Feedback

A

Incorrect. It is true that not all children lose their hair, but this is not the best response.

B

Incorrect. This response does not answer the girls question nor does it address her concerns, but is a distraction technique.

C

Correct. The nurse should explain that her hair will probably start to fall out in 10 days to 2 weeks, but then chemotherapy is complete, her hair will grow back.

D

Incorrect. This response does not answer the girls question nor does it address her concerns.

PTS:1REF:p. 1037 Treatment Modalities

OBJ: Cognitive Level: Application

22.The adolescent female who is receiving chemotherapy for cancer will be advised by the nurse of which of the following?

a.

to advise any sexual partners not to use condoms during intercourse

b.

to use pads instead of tampons during menstruation

c.

that females have a greater chance of becoming sterile than their male counterparts

d.

that females will have a normal pubertal development

ANS: B

Feedback

A

Incorrect. The adolescent female who is receiving chemotherapy for cancer will be advised by the nurse to advise any sexual partners to use condoms during intercourse to reduce the risk of infection and pregnancy.

B

Correct. The adolescent female who is receiving chemotherapy for cancer will be advised by the nurse to use pads instead of tampons during menstruation to reduce the risk of infection or trauma.

C

Incorrect. Males have a greater chance of becoming sterile than their female counterparts especially with the use of alkylating agents which have a dramatic effect on spermatogenesis.

D

Incorrect. Females will not necessarily have a normal pubertal development. Prepubertal girls may have delayed pubertal development, and girls who have already started menstruating may develop oligomenorrhea (abnormally light or reduction in menstruation), amenorrhea, excessive bleeding, or menopausal symptoms.

PTS:1REF:p. 1038 Cellular Alterations

OBJ: Cognitive Level: Application

23.The nurse is giving instructions to the family of a child who has a venous access device (VAD). This childs VAD is an external catheter. Which of the following instructions will the nurse give to the family?

a.

Do not force-flush the catheter at any time, and call if any problems with flushing occur.

b.

The catheter needs no special dressings or coverings.

c.

The child is to avoid swimming and tub baths during the entire time the vascular access device is in place.

d.

Trauma to the device is highly likely, and the child must be extremely careful in any activities.

ANS: A

Feedback

A

Correct. The nurse gives the family instructions about not force-flushing the catheter at any time and call if any problems with flushing occur.

B

Incorrect. An external catheter exit site requires sterile dressing changes performed on a schedule.

C

Incorrect. The child can take tub baths or showers. The practitioner should be consulted before swimming which is usually prohibited. Swimming may be allowed in certain situations. If the exit site is healed and the cuff adheres to the tissue, a transparent dressing can be placed over the catheter and exit site, and swimming may be permitted for a limited time in a chlorinated pool.

D

Incorrect. Trauma to the device is highly unlikely because of its location on the upper chest wall.

PTS:1REF:p. 1039 Leukemia

OBJ: Cognitive Level: Application

24.The nurse assigned to work with the child who has had whole brain radiation assesses the child and finds that the child is sleeping up to 20 hours a day and is having some nausea and malaise, a fever, and dysphasia. Based on this assessment, the nurse will work with the parents in which of the following areas?

a.

caring for the dying child

b.

dealing with the side effects of radiation therapy

c.

accepting a reoccurrence of the tumor

d.

accepting the imminent death of their child

ANS: B

Feedback

A

Incorrect. These symptoms do not mean the child is dying.

B

Correct. Whole brain radiation can cause acute, subacute, and delayed toxicity. Symptoms of subacute toxicity, called somnolence syndrome, are sleepiness, nausea, malaise, fever, and dysphagia. The nurse will work with the parents in dealing with the side effects of radiation therapy.

C

Incorrect. These symptoms do not indicate reoccurrence of the tumor.

D

Incorrect. These symptoms do not indicate the imminent death of their child.

PTS:1REF:p. 1043 Wilms Tumor

OBJ: Cognitive Level: Application

25.Which of the following are the most common presenting signs of acute lymphocytic leukemia (ALL)?

a.

blurred vision, dizziness, and changes in behaviors

b.

bleeding and severe hemorrhaging

c.

nodules in various locations on the body

d.

fever, bone pain, pallor, and bruising

ANS: D

Feedback

A

Incorrect. Blurred vision, dizziness, and changes in behaviors are not the most common presenting signs of ALL.

B

Incorrect. Bleeding and severe hemorrhaging are not the most common presenting signs of ALL.

C

Incorrect. Nodules in various locations on the body are not the most common presenting signs of ALL.

D

Correct. The most common presenting signs of acute lymphocytic leukemia (ALL) are fever, bone pain, pallor, and bruising.

PTS:1REF:p. 1047 Cellular Alterations

OBJ: Cognitive Level: Comprehension

26.The nurse caring for a child with acute lymphocytic leukemia is aware that once chemotherapy begins, there is a release of purines from the destroyed leukemic lymphoblasts, which can lead to which of the following problems?

a.

tumor lysis syndrome

c.

altered mental states

b.

metastasis to the lungs

d.

gout

ANS: A

Feedback

A

Correct. For a child with ALL, once chemotherapy begins, there is a release of purines from the destroyed leukemic lymphoblasts, which can lead to tumor lysis syndrome.

B

Incorrect. For a child with ALL, once chemotherapy begins, there is a release of purines from the destroyed leukemic lymphoblasts, which does not lead to metastasis to the lungs.

C

Incorrect. For a child with ALL, once chemotherapy begins, there is a release of purines from the destroyed leukemic lymphoblasts, which does not lead to altered mental states.

D

Incorrect. For a child with ALL, once chemotherapy begins, there is a release of purines from the destroyed leukemic lymphoblasts, which does not lead to gout.

PTS:1REF:p. 1047 Cellular Alterations

OBJ: Cognitive Level: Comprehension

27.What is the most common type of central nervous system tumor in children?

a.

medulloblastomas

c.

ependymomas

b.

astrocytomas

d.

craniopharyngiomas

ANS: B

Feedback

A

Incorrect. The most common type of central nervous system tumor in children is not medulloblastomas.

B

Correct. The most common type of central nervous system tumor in children is astrocytomas.

C

Incorrect. The most common type of central nervous system tumor in children is not ependymomas.

D

Incorrect. The most common type of central nervous system tumor in children is not craniopharyngiomas.

PTS: 1 REF: p. 1051 Cellular Alterations OBJ: Cognitive Level: Knowledge

COMPLETION

1.A child is said to be a long-term survivor then he has been off cancer therapy for a minimum of two years and is in remission for ____________________ years.

ANS:

5

five

PTS:1REF:p. 1060 Anatomy and Physiology

OBJ: Cognitive Level: Comprehension

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