Chapter 24: Leukemia

Question 1

A 3-year-old boy is brought to the pediatric clinic with complaints of fatigue, fever, and bruising. His mother states he has been unusually irritable and has developed multiple nosebleeds over the past few weeks. A complete blood count (CBC) reveals anemia, thrombocytopenia, and leukocytosis with blasts.
Based on the clinical presentation and lab findings, what is the most likely diagnosis?

A. Acute lymphoblastic leukemia (ALL)
B. Acute myelogenous leukemia (AML)
C. Chronic myelocytic leukemia (CML)
D. Iron-deficiency anemia

Answer 1

A. Acute lymphoblastic leukemia (ALL)

Rationale: Fatigue, fever, bruising, and nosebleeds are hallmark signs of ALL, which is the most common leukemia in children aged 2–3 years. The CBC findings of anemia, thrombocytopenia, and blast cells also support the diagnosis of ALL.

Question 2

Rasheed, a 12-year-old boy diagnosed with ALL, is beginning chemotherapy. During an assessment, the nurse notes that Rasheed appears pale and has a fever of 101.3°F (38.5°C). His mother reports he has been complaining of a sore throat. What is the nurse’s priority intervention?

A. Administer acetaminophen to reduce the fever.
B. Assess Rasheed’s complete blood count and notify the oncologist.
C. Provide oral hygiene instructions to prevent infection.
D. Encourage Rasheed to rest and increase fluid intake.

Answer 2

B. Assess Rasheed’s complete blood count and notify the oncologist.

Rationale: Fever and sore throat in a child with ALL undergoing chemotherapy may indicate neutropenia and infection, requiring immediate assessment of CBC and prompt medical intervention.

Question 3

Which child is at the highest risk for developing acute lymphoblastic leukemia (ALL)?

A. A 2-year-old African American girl
B. A 14-year-old Hispanic boy
C. A 1-year-old Asian girl
D. A 3-year-old White boy

Answer 3

D. A 3-year-old White boy

Rationale: ALL is most common in White children, with a peak age of onset between 2 and 3 years. It also occurs more frequently in boys.

Question 4

A 15-month-old girl is diagnosed with acute myelogenous leukemia (AML). Her parents ask the nurse how this condition differs from acute lymphoblastic leukemia (ALL). Which statement by the nurse provides the best explanation?

A. “ALL affects lymphoid cells, while AML affects myeloid cells.”
B. “AML is more common in school-age children, while ALL occurs mostly in infants.”
C. “AML has a higher survival rate compared to ALL.”
D. “ALL progresses more slowly than AML in children.”

Answer 4

A. “ALL affects lymphoid cells, while AML affects myeloid cells.”

Rationale: ALL arises from lymphoid cells, while AML arises from myeloid cells. AML is less common but occurs more frequently in infants and adolescents.

Question 5

What is the primary reason children with leukemia often present with anemia and thrombocytopenia?

A. Chemotherapy suppresses the bone marrow.
B. Increased infections lead to destruction of red blood cells and platelets.
C. Leukemic cells inhibit the production of healthy blood cells.
D. A vitamin deficiency caused by leukemia reduces blood cell production.

Answer 5

C. Leukemic cells inhibit the production of healthy blood cells.

Rationale: Leukemic cells proliferate in the bone marrow, reducing the production of normal red blood cells and platelets, leading to anemia and thrombocytopenia.

Question 6

A 16-month-old child with AML is receiving chemotherapy. The parents report that the child has been vomiting frequently and is unable to tolerate oral intake. What is the priority nursing intervention?

A. Administer antiemetics as prescribed and monitor fluid balance.
B. Encourage the parents to offer small, frequent meals.
C. Begin oral rehydration therapy to replace lost fluids.
D. Schedule a feeding tube placement.

Answer 6

A. Administer antiemetics as prescribed and monitor fluid balance.

Rationale: Antiemetics should be administered to reduce chemotherapy-induced nausea and vomiting. Fluid balance must be closely monitored to prevent dehydration.

Question 7

Which of the following is a distinguishing characteristic of acute lymphoblastic leukemia (ALL) compared to acute myelogenous leukemia (AML)?

A. ALL is more common in adolescents, while AML is more common in young children.
B. ALL is more common in African Americans, while AML is more common in Whites.
C. ALL has a lower survival rate compared to AML.
D. ALL arises from lymphoid cells, while AML arises from myeloid cells.

Answer 7

D. ALL arises from lymphoid cells, while AML arises from myeloid cells.

Rationale: ALL arises from lymphoid cells, whereas AML originates from myeloid cells. ALL is more common in younger children, and AML is more common in infants and adolescents.

Question 8

A 6-year-old boy presents with fatigue, recurrent infections, and nosebleeds. Laboratory results reveal anemia, thrombocytopenia, and leukocytosis with a high percentage of immature white blood cells. His medical history is significant for Down syndrome.
Based on the child’s medical history and clinical findings, which condition is most likely contributing to his symptoms?

A. Iron-deficiency anemia
B. Acute lymphoblastic leukemia (ALL)
C. Idiopathic thrombocytopenic purpura (ITP)
D. Acute myelogenous leukemia (AML)

Answer 8

B. Acute lymphoblastic leukemia (ALL)

Rationale: Children with Down syndrome are at a significantly increased risk of developing ALL. Symptoms such as fatigue, infections, and bleeding, along with lab results showing anemia, thrombocytopenia, and leukocytosis with blasts, are hallmark findings of leukemia.

Question 9

A 4-year-old girl with a history of Wiskott-Aldrich syndrome presents with fever, bruising, and pallor. A bone marrow biopsy confirms acute lymphoblastic leukemia (ALL). What underlying condition most likely predisposed the child to ALL?

A. A previous history of ionizing radiation exposure
B. Congenital immune deficiency
C. Neurofibromatosis type I
D. Chemotherapy treatment for a prior cancer

Answer 9

B. Congenital immune deficiency

Rationale: Wiskott-Aldrich syndrome is a congenital immune deficiency that increases the risk of developing ALL.

Question 10

Which chromosomal abnormality is associated with an increased risk of developing acute lymphoblastic leukemia (ALL)?

A. Turner syndrome
B. Klinefelter syndrome
C. Fragile X syndrome
D. Down syndrome

Answer 10

D. Down syndrome

Rationale: Down syndrome is associated with a significantly increased incidence of ALL, as well as other hematologic malignancies.

Question 11

A 7-year-old boy with a history of chemotherapy treatment for retinoblastoma is now diagnosed with acute myelogenous leukemia (AML). What is the most likely etiology of his leukemia?

A. Genetic predisposition
B. Previous exposure to ionizing radiation
C. Previous chemotherapy treatment
D. Congenital chromosomal defect

Answer 11

C. Previous chemotherapy treatment

Rationale: Chemotherapy treatment for other cancers is a known risk factor for the development of AML.

Question 12

Which of the following explains the increased susceptibility to infections in children with leukemia?

A. Malignant WBCs are immature and cannot perform normal immune functions.

B. Immature WBCs crowd out platelets, reducing clotting ability.

C. Bone marrow fails to produce enough hemoglobin for oxygen transport.

D. Abnormal WBCs increase the risk of autoimmune disorders.

Answer 12

A. Malignant WBCs are immature and cannot perform normal immune functions.

Rationale: In leukemia, immature WBCs proliferate abnormally, replacing normal WBCs and reducing the body’s ability to fight infections.

Question 13

A 5-year-old boy presents with petechiae, fatigue, and recurrent infections. Lab results reveal pancytopenia and the presence of leukemic blasts. The nurse understands that these findings are caused by:

A. Destruction of healthy blood cells by malignant WBCs.
B. Increased production of abnormal platelets by the bone marrow.
C. Replacement of normal stem cells in the bone marrow by leukemic cells.
D. Infiltration of the spleen and liver by abnormal WBCs.

Answer 13

C. Replacement of normal stem cells in the bone marrow by leukemic cells.

Rationale: Leukemic cells in the bone marrow replace normal stem cells, leading to pancytopenia, which manifests as anemia, thrombocytopenia, and increased infection risk.

Question 14

Which of the following syndromes is most likely associated with an increased risk of acute myelogenous leukemia (AML)?

A. Neurofibromatosis type I
B. Shwachman syndrome
C. Ataxia-telangiectasia
D. Bloom syndrome

Answer 14

A. Neurofibromatosis type I

Rationale: Neurofibromatosis type I is associated with an increased risk of AML, among other hematologic malignancies.

Question 15

A newborn with a history of Bloom syndrome develops petechiae and ecchymosis. A bone marrow biopsy reveals acute lymphoblastic leukemia (ALL).
What aspect of the child’s history likely contributed to this condition?

A. Immune deficiency associated with Bloom syndrome
B. Exposure to maternal chemotherapy in utero
C. Ionizing radiation exposure during pregnancy
D. Familial history of leukemia

Answer 15

A. Immune deficiency associated with Bloom syndrome

Rationale: Bloom syndrome, a congenital condition characterized by chromosomal instability, increases the risk of developing ALL.

Question 16

Why are children with leukemia at increased risk for anemia?

A. Increased destruction of erythrocytes by leukemic cells
B. Reduced erythrocyte production due to overcrowding of the bone marrow by leukemic cells
C. Chronic blood loss caused by gastrointestinal bleeding
D. Hemolysis caused by chemotherapy

Answer 16

B. Reduced erythrocyte production due to overcrowding of the bone marrow by leukemic cells

Rationale: Leukemic cells rapidly proliferate in the bone marrow, replacing normal stem cells, which leads to decreased erythrocyte production and anemia.

Question 17

A 10-year-old boy undergoing evaluation for fatigue and bruising is diagnosed with leukemia. His lab results include low platelets and abnormal leukocytes. His parents ask why he is bruising so easily. Which explanation is most appropriate?

A. “The cancer is causing your son’s blood vessels to become fragile.”
B. “The abnormal white blood cells are attacking healthy platelets.”
C. “Infections caused by leukemia are damaging your son’s platelets.”
D. “Leukemia reduces the number of platelets needed for blood clotting.”

Answer 17

D. “Leukemia reduces the number of platelets needed for blood clotting.”

Rationale: Leukemia reduces platelet production because the bone marrow is overcrowded with leukemic cells, which leads to bruising and other bleeding abnormalities.

Question 18

A 4-year-old girl presents with fever, anorexia, and pallor. Upon examination, her spleen and liver are enlarged. Her parents report she has been experiencing persistent joint pain. What diagnostic step should be prioritized to confirm leukemia?

A. Lumbar puncture
B. Bone marrow aspiration
C. Complete blood count with differential
D. Abdominal ultrasound

Answer 18

B. Bone marrow aspiration

Rationale: Bone marrow aspiration is the definitive diagnostic test for leukemia, allowing direct observation of leukemic cell proliferation in the bone marrow.

Question 19

A child diagnosed with ALL develops a new symptom: difficulty moving their left eye laterally. Which cranial nerve is most likely affected?

A. Third cranial nerve
B. Fourth cranial nerve
C. Sixth cranial nerve
D. Seventh cranial nerve

Answer 19

C. Sixth cranial nerve

Rationale: The sixth cranial nerve controls lateral eye movement. Leukemic cell massing in the CNS can put pressure on this nerve, causing palsy and restricted lateral movement of the eye.

Question 20

A 10-year-old boy presents with fever, lethargy, pallor, and joint pain. On physical examination, petechiae and hepatosplenomegaly are noted. Which finding would most strongly suggest infiltration of leukemia into the central nervous system?

A. Lymphadenopathy
B. Enlarged testicles
C. Papilledema
D. Sixth cranial nerve palsy

Answer 20

D. Sixth cranial nerve palsy

Rationale: Sixth cranial nerve palsy, characterized by the inability to move the eye laterally, is a specific sign of CNS infiltration by leukemic cells.

Question 21

A 6-year-old boy is diagnosed with acute lymphoblastic leukemia (ALL). His parents report that he has been experiencing bone pain and has difficulty walking. Which pathophysiological process explains his symptoms?

A. Bone marrow expansion due to leukemic cell proliferation
B. Infiltration of leukemic cells into the central nervous system
C. Reduced production of erythrocytes leading to hypoxia
D. Autoimmune destruction of healthy bone cells

Answer 21

A. Bone marrow expansion due to leukemic cell proliferation

Rationale: Proliferation of leukemic cells in the bone marrow can cause expansion and pressure within the bone, leading to pain and difficulty walking.

Question 22

A child with AML presents with painless enlargement of the testicles. What is the most likely underlying cause of this manifestation?

A. Inflammation due to leukemic cell activity
B. Hematoma formation from thrombocytopenia
C. Tumor formation from leukemic cell infiltration
D. Hypoxia-induced swelling

Answer 22

C. Tumor formation from leukemic cell infiltration

Rationale: Leukemic cells can infiltrate the testicles, leading to the formation of a painless mass and subsequent enlargement of the testicle.

Question 23

A 12-year-old girl with ALL has been experiencing persistent headaches and vomiting. On examination, papilledema is observed. What is the most likely explanation for her symptoms?

A. Dehydration due to anorexia
B. Infiltration of leukemic cells into the CNS causing increased intracranial pressure
C. Hepatosplenomegaly leading to systemic inflammation
D. Side effect of chemotherapy

Answer 23

B. Infiltration of leukemic cells into the CNS causing increased intracranial pressure

Rationale: CNS infiltration by leukemic cells can lead to increased intracranial pressure, causing symptoms such as headache, vomiting, and papilledema.

Question 24

Which combination of clinical findings is most indicative of bone marrow failure in a child with leukemia?

A. Fever, anorexia, and hepatosplenomegaly
B. Lymphadenopathy, headache, and papilledema
C. Enlarged testicle, pallor, and vomiting
D. Petechiae, frank bleeding, and joint pain

Answer 24

D. Petechiae, frank bleeding, and joint pain

Rationale: Petechiae, frank bleeding, and joint pain are hallmark signs of bone marrow failure in leukemia, caused by reduced production of platelets, erythrocytes, and normal white blood cells.

Question 25

Which diagnostic test is definitive for confirming leukemia?

A. Complete blood count (CBC)
B. Bone marrow aspiration
C. Serum uric acid level
D. Flow cytometric assay

Answer 25

B. Bone marrow aspiration

Rationale: Bone marrow aspiration reveals immature and abnormal lymphoblasts and hypercellular marrow, making it the definitive diagnostic test for leukemia.

Question 26

A 5-year-old child is diagnosed with ALL. The initial blood work shows anemia, thrombocytopenia, and neutropenia. What phase of chemotherapy is focused on achieving maximum cell death and remission?

A. Consolidation
B. Induction
C. Delayed intensification
D. Maintenance

Answer 26

B. Induction

Rationale: The induction phase is aimed at achieving maximum cell death to induce remission.

Question 27

A child with ALL is undergoing the consolidation phase of treatment. Which medication is typically administered during this phase?

A. L-asparaginase
B. Vincristine
C. Methotrexate
D. Doxorubicin

Answer 27

A. L-asparaginase

Rationale: L-asparaginase is commonly administered during the consolidation phase to target leukemic cells.

Question 28

What is the significance of a leukocyte count above 50,000 at the time of diagnosis in children with leukemia?

A. It is indicative of a better prognosis.
B. It increases the likelihood of CNS involvement.
C. It correlates with a worse prognosis.
D. It requires immediate HSCT.

Answer 28

C. It correlates with a worse prognosis.

Rationale: A higher leukocyte count at diagnosis is associated with a worse prognosis.

Question 29

A 7-year-old child with AML relapses one year after completing treatment. What treatment option would most likely be recommended next?

A. Maintenance chemotherapy
B. Cranial irradiation
C. Hematopoietic stem cell transplant (HSCT)
D. L-asparaginase therapy

Answer 29

C. Hematopoietic stem cell transplant (HSCT)

Rationale: HSCT is recommended for children who relapse and achieve a second remission in ALL or for AML, even if remission has not been achieved.

Question 30

During which phase of chemotherapy for ALL are additional drugs introduced to target surviving leukemic cells?

A. Maintenance
B. Consolidation
C. Delayed intensification
D. Induction

Answer 30

C. Delayed intensification

Rationale: The delayed intensification phase introduces additional drugs to target leukemic cells that have survived earlier treatments.

Question 31

A 6-year-old child undergoing treatment for ALL presents with elevated serum uric acid, hypocalcemia, and hyperphosphatemia. What condition should the nurse monitor for based on these lab findings?

A. Tumor lysis syndrome
B. CNS infiltration
C. Anemia
D. Thrombocytopenia

Answer 31

A. Tumor lysis syndrome

Rationale: Elevated uric acid, hypocalcemia, and hyperphosphatemia are hallmark findings of tumor lysis syndrome, which can occur during leukemia treatment.

Question 32

Which factor has the most significant impact on the prognosis of a child with leukemia?

A. FAB classification type
B. Age at diagnosis
C. Presence of hepatosplenomegaly
D. Initial leukocyte count

Answer 32

D. Initial leukocyte count

Rationale: The initial leukocyte count is a critical prognostic factor, with higher counts being associated with worse outcomes.

Question 33

A 10-year-old with ALL has CNS involvement. What treatment is most appropriate to address this complication?

A. L-asparaginase
B. Cranial irradiation and intrathecal chemotherapy
C. Hematopoietic stem cell transplant
D. Vincristine and prednisone

Answer 33

B. Cranial irradiation and intrathecal chemotherapy

Rationale: CNS involvement in leukemia is treated with cranial irradiation and intrathecal chemotherapy to target leukemic cells in the CNS.

Question 34

What is the primary goal of the maintenance phase of chemotherapy in ALL treatment?

A. Reduce CNS involvement
B. Destroy remaining leukemic cells
C. Induce remission
D. Prevent anemia and thrombocytopenia

Answer 34

B. Destroy remaining leukemic cells

Rationale: The maintenance phase focuses on destroying any remaining leukemic cells to prevent relapse.

Question 35

A child with ALL is being monitored for minimal residual disease (MRD). What laboratory test is most effective for identifying very small numbers of leukemic cells?

A. Bone marrow aspiration
B. Rapid flow cytometric assay
C. Complete blood count (CBC)
D. Serum uric acid level

Answer 35

B. Rapid flow cytometric assay

Rationale: Rapid flow cytometric assay is a sensitive test for detecting minimal residual disease, improving treatment outcomes.

Question 36

Which drug combination is most commonly used during the induction phase of ALL treatment?

A. Vincristine, prednisone, and methotrexate
B. Cyclophosphamide and doxorubicin
C. L-asparaginase and vincristine
D. Cytosine arabinoside and anthracyclines

Answer 36

A. Vincristine, prednisone, and methotrexate

Rationale: Vincristine, prednisone, and methotrexate are commonly used during the induction phase to achieve remission.

Question 37

A 3-year-old with ALL is receiving cranial irradiation as part of their treatment. What is the primary indication for this therapy?

A. Testicular infiltration
B. Bone marrow failure
C. CNS disease involvement
D. Elevated leukocyte count

Answer 37

C. CNS disease involvement

Rationale: Cranial irradiation is primarily used to treat CNS disease involvement in children with ALL.

Question 38

A child with relapsed ALL has been recommended for a hematopoietic stem cell transplant. What is the primary requirement for proceeding with this treatment?

A. The child must have a low initial leukocyte count.
B. The child must have minimal residual disease.
C. The child must achieve a second remission.
D. The child must have CNS involvement.

Answer 38

C. The child must achieve a second remission.

Rationale: For children with ALL who relapse, achieving a second remission is necessary before undergoing hematopoietic stem cell transplantation.

Question 40

A child undergoing chemotherapy for leukemia has a central line. What is the priority nursing action when assessing the central line?

A. Check for proper line placement.
B. Assess the child for signs of infection.
C. Monitor for patency during medication infusion.
D. Evaluate the child’s tolerance to intravenous fluids.

Answer 40

B. Assess the child for signs of infection.

Rationale: A central line increases the risk of infection. Regular assessment for redness, swelling, or discharge is essential to prevent complications.

Question 41

What is the most important nursing intervention for a child with leukemia experiencing mucosal ulcers in the mouth?

A. Provide frequent oral care using a soft toothbrush.
B. Administer antiemetic medications.
C. Restrict the child’s dietary intake of acidic foods.
D. Encourage increased oral fluid intake.

Answer 41

A. Provide frequent oral care using a soft toothbrush.

Rationale: Frequent, gentle oral care with a soft toothbrush can minimize discomfort and prevent secondary infection from mucosal ulcers.

Question 42

A nurse is assessing a child undergoing treatment for leukemia who presents with irritability, lethargy, and vomiting. What is the most likely cause of these symptoms?

A. Side effects of antiemetic medications
B. Dehydration from chemotherapy
C. Chemotherapy-induced mucositis
D. CNS infiltration by leukemic cells

Answer 42

D. CNS infiltration by leukemic cells

Rationale: CNS infiltration can cause irritability, lethargy, and vomiting by increasing intracranial pressure.

Question 43

When monitoring renal function in a child receiving chemotherapy, which parameter is most critical to assess?

A. Daily fluid intake
B. Serum calcium levels
C. Specific gravity of urine
D. Number of voiding episodes

Answer 43

C. Specific gravity of urine

Rationale: Specific gravity of urine helps monitor kidney function, ensuring the child is maintaining proper hydration and renal clearance.

Question 44

A child with leukemia exhibits petechiae and bruising. What nursing diagnosis is most appropriate for this finding?

A. Pain, Acute related to disease process
B. Injury, Risk for related to bleeding
C. Anxiety (Child and Parent) related to change in health status
D. Infection, Risk for related to altered immune system functioning

Answer 44

B. Injury, Risk for related to bleeding

Rationale: Petechiae and bruising indicate impaired clotting, placing the child at risk for bleeding.

Question 45

A nurse is teaching the family of a child with leukemia about signs of infection to report. Which signs should the family be instructed to monitor? (Select all that apply.)

A. Fever
B. Redness around the central line site
C. Decreased appetite
D. Nausea after meals
E. Lethargy

Answer 45

A. Fever
B. Redness around the central line site
E. Lethargy

Rationale: Fever, redness around the central line, and lethargy are signs of potential infection. Nausea and decreased appetite are common chemotherapy side effects but not specific to infection.

Question 46

Which nursing diagnosis is most appropriate for a child who is lethargic and has generalized weakness during leukemia treatment?

A. Sleep Pattern, Disturbed
B. Pain, Acute
C. Nutrition, Imbalanced: Less than Body Requirements
D. Activity Intolerance

Answer 46

D. Activity Intolerance

Rationale: Generalized weakness and lethargy indicate limited ability to participate in physical activities, supporting a diagnosis of Activity Intolerance.

Question 47

A nurse observes that a child undergoing frequent venipunctures for leukemia treatment is crying and resisting the procedure. What should the nurse prioritize in this situation?

A. Requesting a sedative before future procedures
B. Assessing the child’s level of pain and fear
C. Postponing the procedure until the child is calm
D. Explaining the procedure again to the child

Answer 47

B. Assessing the child’s level of pain and fear

Rationale: Assessing pain and fear is a priority to address the child’s emotional and physical needs during procedures.

Question 48

Which nursing action is most effective in managing imbalanced nutrition in a child with leukemia?

A. Administer antiemetics before meals.
B. Offer large, calorie-dense meals twice daily.
C. Encourage family members to bring the child’s favorite foods.
D. Place the child on a clear liquid diet.

Answer 48

A. Administer antiemetics before meals.

Rationale: Administering antiemetics before meals reduces nausea, allowing the child to eat more effectively.

Question 49

A child with leukemia is noted to have anxiety related to health changes. What is the most appropriate intervention to reduce anxiety for both the child and family?

A. Provide detailed explanations about treatments.
B. Offer distractions such as toys or games.
C. Encourage open communication about feelings.
D. Limit discussions about the child’s condition.

Answer 49

C. Encourage open communication about feelings.

Rationale: Open communication helps address the emotional needs of both the child and family, reducing anxiety.

Question 50

What is the priority nursing intervention for a child with leukemia who has a fever?

A. Administer antipyretic medication.
B. Apply cooling measures such as a cold compress.
C. Monitor the child’s fluid intake and output.
D. Obtain blood cultures and start antibiotics as ordered.

Answer 50

D. Obtain blood cultures and start antibiotics as ordered.

Rationale: Fever in a child with leukemia is an emergency due to the risk of infection; blood cultures and prompt antibiotic administration are critical.

Question 51

A nurse is caring for a child receiving cyclophosphamide for leukemia. What is the priority nursing intervention to prevent complications from this drug?

A. Administer the drug at the prescribed infusion time.

B. Ensure the child receives 1.5 times maintenance volume of intravenous fluids before and after the drug infusion.

C. Monitor the child for signs of peripheral extravasation.

D. Administer antiemetic medications before chemotherapy.

Answer 51

B. Ensure the child receives 1.5 times maintenance volume of intravenous fluids before and after the drug infusion.

Rationale: Cyclophosphamide requires hydration to reduce the risk of gross hematuria and to help the kidneys manage tumor cell breakdown products.

Question 52

What is the purpose of monitoring specific gravity every 8 hours during chemotherapy for a child with leukemia?

A. To assess kidney function and hydration status
B. To evaluate the effectiveness of chemotherapy drugs
C. To monitor blood pressure and fluid balance
D. To measure tumor cell lysis

Answer 52

A. To assess kidney function and hydration status

Rationale: Monitoring specific gravity helps assess kidney function and hydration status, which is crucial when using chemotherapy drugs like cyclophosphamide.

Question 53

A nurse is providing care for a child undergoing chemotherapy for leukemia. The child is exhibiting signs of infection such as a fever and oral sores. What is the most important nursing intervention?

A. Administer antibiotics as prescribed.
B. Encourage the child to drink fluids and rest.
C. Perform frequent hand hygiene and inspect for other signs of infection.
D. Apply topical creams to mouth sores to relieve discomfort.

Answer 53

C. Perform frequent hand hygiene and inspect for other signs of infection.

Perform frequent hand hygiene and inspect for other signs of infection.

Question 54

When caring for a child with leukemia receiving chemotherapy, what is a priority nursing action to prevent complications of extravasation?

A. Ensure the child is receiving chemotherapy through a central line.
B. Monitor for signs of extravasation during the drug infusion.
C. Check for fever and signs of systemic infection.
D. Educate the family on administering chemotherapy drugs at home.

Answer 54

B. Monitor for signs of extravasation during the drug infusion.

Rationale: Extravasation of chemotherapeutic agents can be highly toxic to tissues, so monitoring during infusion is essential to prevent damage.

Question 55

What is an appropriate nursing intervention to support renal function during chemotherapy with cyclophosphamide?

A. Encourage high-calorie, low-fluid intake.
B. Administer a diuretic to increase urine output.
C. Maintain intravenous fluid hydration before and after drug infusion.
D. Restrict fluid intake to prevent overhydration.

Answer 55

C. Maintain intravenous fluid hydration before and after drug infusion.

Rationale: Hydration with intravenous fluids helps prevent hematuria and supports renal function during chemotherapy with cyclophosphamide.

Question 56

A child with leukemia is receiving chemotherapy and exhibits signs of dehydration. What is the priority nursing intervention to address this issue?

A. Administer intravenous fluids according to the prescribed plan.
B. Offer the child small, frequent meals.
C. Decrease intravenous fluids to avoid fluid overload.
D. Monitor the child’s blood pressure for hypotension.

Answer 56

A. Administer intravenous fluids according to the prescribed plan.

Rationale: Administering intravenous fluids as prescribed ensures proper hydration and supports kidney function during chemotherapy.

Question 57

When a child with leukemia is treated in an oncology clinic and only visits the hospital for chemotherapy administration, which is the priority for the nurse to assess?

A. Nutritional intake, sleep, and medication adherence
B. Pain management and tissue integrity
C. Infection prevention and hydration status
D. Family psychosocial support and coping strategies

Answer 57

A. Nutritional intake, sleep, and medication adherence

Rationale: The nurse should assess the family’s ability to manage the child’s nutritional intake, sleep, and medication administration while at home.

Question 58

A nurse is educating the family of a child with leukemia about administering chemotherapy medications at home. Which instruction should the nurse include?

A. Store chemotherapy medications in a cool, dark place.
B. Only administer oral chemotherapy medications at night.
C. Carefully follow the prescribed medication schedule and dosage.
D. Administer chemotherapy drugs only during hospitalization.

Answer 58

C. Carefully follow the prescribed medication schedule and dosage.

Rationale: It is essential for the family to follow the prescribed medication schedule and dosage accurately to ensure the effectiveness of the treatment.

Question 59

Which of the following nursing interventions is most important in managing a child’s emotional stress during chemotherapy for leukemia?

A. Encourage the child to engage in physical activities to reduce stress.
B. Provide ongoing psychosocial assessment and emotional support.
C. Limit the child’s interaction with family to prevent overexcitement.
D. Encourage the child to attend school as much as possible.

Answer 59

B. Provide ongoing psychosocial assessment and emotional support.

Rationale: Ongoing psychosocial assessment and emotional support are crucial for managing the emotional stress of both the child and family during leukemia treatment.

Question 60

Which complementary therapy should the nurse monitor for potential interactions with the child’s chemotherapy regimen?

A. Aromatherapy
B. Relaxation techniques
C. Massage therapy
D. Nutritional supplements

Answer 60

D. Nutritional supplements

Rationale: Nutritional supplements may interact with chemotherapy regimens, and the nurse should be vigilant about potential interactions.

Question 61

A child receiving chemotherapy for leukemia has a change in urinary output and gross hematuria. What is the nurse’s priority intervention?

A. Monitor the child’s blood pressure and temperature.
B. Administer intravenous fluids as prescribed to support renal function.
C. Notify the healthcare provider immediately for a change in therapy.
D. Encourage the child to increase oral fluid intake.

Answer 61

B. Administer intravenous fluids as prescribed to support renal function.

Rationale: Hydration with intravenous fluids helps reduce hematuria and supports renal function during chemotherapy with cyclophosphamide.

Question 62

When educating the parents of a child undergoing chemotherapy about preventing infection, which of the following instructions is most important?

A. Ensure that the child wears a mask when around other children.

B. Keep the child away from crowds, but allow playdates with healthy children.

C. Wash the child’s hands before meals and after using the restroom.

D. Administer vaccines as usual during chemotherapy.

Answer 62

C. Wash the child’s hands before meals and after using the restroom.

Rationale: Frequent hand hygiene is the most effective way to prevent infection in children undergoing chemotherapy.

Question 63

A child receiving chemotherapy for leukemia is prescribed intravenous fluids before and after cyclophosphamide infusion. The nurse notes the child has gained 3 pounds since the previous day. What should the nurse do next?

A. Decrease the rate of intravenous fluids to prevent fluid overload.
B. Increase the rate of intravenous fluids to improve hydration.
C. Monitor the child’s weight daily to assess hydration status.
D. Notify the healthcare provider of the weight gain.

Answer 63

A. Decrease the rate of intravenous fluids to prevent fluid overload.

Rationale: Rapid weight gain may indicate fluid retention. The nurse should reassess the hydration plan and consider adjusting fluid administration.

Question 64

Which of the following is a key aspect of teaching parents to administer chemotherapy medications at home for a child with leukemia?

A. Administer medications at the same time every day.
B. Store medications in a humid environment.
C. Administer chemotherapy medications with food for better absorption.
D. Limit the child’s activity while taking chemotherapy medications.

Answer 64

A. Administer medications at the same time every day.

Rationale: Administering chemotherapy medications at the same time each day helps ensure consistency and effectiveness.

Question 65

A nurse is educating a family about the potential side effects of chemotherapy in their child with leukemia. Which of the following side effects should the nurse specifically monitor for during chemotherapy?

A. Weight loss and fatigue
B. Diarrhea and dehydration
C. Increased appetite and hyperactivity
D. Nausea and mouth sores

Answer 65

D. Nausea and mouth sores

Question 66

Which of the following interventions should be prioritized when caring for a child undergoing chemotherapy for leukemia?

A. Encourage rest periods and avoid overexertion.
B. Administer pain medication before meals.
C. Limit contact with friends and family to prevent infections.
D. Increase exposure to the sun to improve vitamin D levels.

Answer 66

A. Encourage rest periods and avoid overexertion.

Rationale: Rest periods are essential to prevent fatigue and help the child’s body recover during chemotherapy.

Question 67

A nurse is educating the family of a child with leukemia about dietary needs during chemotherapy. Which of the following recommendations should the nurse include?

A. Serve three large meals per day to ensure proper nutrition.
B. Encourage the child to drink fluids only when thirsty.
C. Offer small, frequent meals to improve nutrient intake.
D. Avoid giving any liquids to the child to reduce nausea.

Answer 67

C. Offer small, frequent meals to improve nutrient intake.

Rationale: Small, frequent meals help the child obtain adequate nutrients and reduce nausea during chemotherapy.

Question 68

A child with leukemia is experiencing nausea as a side effect of chemotherapy. What is the most appropriate nursing intervention?

A. Administer antiemetic medications as prescribed.
B. Encourage the child to avoid eating to reduce stomach irritation.
C. Offer large meals to ensure the child eats enough.
D. Limit fluid intake to prevent bloating.

Answer 68

A. Administer antiemetic medications as prescribed.

Rationale: Antiemetic medications help alleviate nausea and allow the child to tolerate chemotherapy better.

Question 69

A child undergoing chemotherapy for leukemia has developed mouth sores. Which of the following interventions is most appropriate for the nurse to recommend?

A. Use a hard-bristled toothbrush to prevent plaque buildup.
B. Administer antibiotics to prevent infection in the mouth sores.
C. Encourage the child to practice good oral hygiene with a soft toothbrush and water irrigation device.
D. Limit oral care to avoid irritating the sores.

Answer 69

C. Encourage the child to practice good oral hygiene with a soft toothbrush and water irrigation device.

Rationale: A soft toothbrush and water irrigation device help maintain good oral hygiene without irritating the mouth sores.

Question 70

Which of the following actions should be emphasized for a child with leukemia to promote bowel elimination?

A. Offer high-fat foods to slow bowel movements.
B. Encourage the child to use the toilet regularly and consume fiber-rich foods.
C. Limit fluid intake to prevent diarrhea.
D. Discourage the child from using the toilet if they do not feel the urge.

Answer 70

B. Encourage the child to use the toilet regularly and consume fiber-rich foods.

Rationale: Regular toileting and a fiber-rich diet help promote healthy bowel movements during chemotherapy.

Question 71

A nurse is discussing sun protection with the parents of a child undergoing chemotherapy. What instruction is most important for the nurse to give?

A. Allow the child to spend short periods in the sun to prevent vitamin D deficiency.
B. Ensure the child wears sunscreen and protective clothing when outside.
C. Avoid applying sunscreen to the child’s skin to reduce irritation.
D. Keep the child indoors at all times to avoid sun exposure.

Answer 71

B. Ensure the child wears sunscreen and protective clothing when outside.

Rationale: Sunscreen and protective clothing help prevent skin damage during chemotherapy, as the child’s skin may be more sensitive.

Question 72

What should the nurse advise the family regarding emotional care for a child with leukemia undergoing chemotherapy?

A. Avoid talking about the illness to reduce anxiety.
B. Discourage the child from staying in contact with friends to avoid stress.
C. Encourage the child to keep a journal of their feelings and experiences.
D. Limit the child’s expression of feelings to prevent emotional distress.

Answer 72

C. Encourage the child to keep a journal of their feelings and experiences.

Rationale: Keeping a journal helps the child express their feelings and cope with the emotional challenges of leukemia treatment.

Question 73

A child undergoing chemotherapy for leukemia is feeling isolated and sad about losing their hair. What is the best intervention for the nurse to suggest?

A. Suggest the child avoid talking about the hair loss with others.
B. Recommend that the child wear hats, wigs, or other alternatives to manage hair loss.
C. Encourage the child to embrace the hair loss as a sign of bravery.
D. Avoid discussing hair loss to prevent upsetting the child.

Answer 73

B. Recommend that the child wear hats, wigs, or other alternatives to manage hair loss.

Rationale: Wearing hats, wigs, or other alternatives can help the child feel more comfortable and confident during chemotherapy.

Question 74

Which of the following actions should the nurse take to help a child with leukemia manage the side effects of chemotherapy?

A. Limit fluids and food intake to reduce the risk of nausea.
B. Avoid discussing the child’s illness with them to prevent distress.
C. Ensure the child remains isolated to prevent exposure to infections.
D. Encourage relaxation techniques to aid in sleep and stress management.

Answer 74

D. Encourage relaxation techniques to aid in sleep and stress management.

Rationale: Relaxation techniques can help the child manage stress and improve sleep during chemotherapy.

Question 75

A nurse is discussing infection prevention with the family of a child undergoing chemotherapy for leukemia. Which of the following is the most important advice to give the family?

A. Encourage the child to stay in bed to avoid exposure to germs.

B. Suggest that the child avoid brushing their teeth to prevent mouth injury.

C. Limit the child’s contact with parents to prevent germ transmission.

D. Teach the family to monitor the child for any signs of infection and report changes in condition.

Answer 75

D. Teach the family to monitor the child for any signs of infection and report changes in condition.

Rationale: Monitoring for signs of infection and promptly reporting changes are essential for preventing complications in children undergoing chemotherapy.

Question 76

Which of the following is an expected outcome for the nursing care of a child undergoing chemotherapy for leukemia?

A. The child experiences increased episodes of infection.

B. The child maintains adequate hydration and normal urinary output.

C. The child develops abnormal blood values, requiring frequent transfusions.

D. The family shows signs of significant emotional distress without coping strategies.

Answer 76

B. The child maintains adequate hydration and normal urinary output.

Rationale: Adequate hydration and normal urinary output are essential outcomes for preventing complications and managing chemotherapy side effects.

Question 77

A nurse is evaluating the progress of a child receiving chemotherapy for leukemia. Which of the following findings indicates that the care plan is being successfully implemented?

A. The child has frequent hospital admissions due to infections.

B. The family is able to manage the child’s nutritional needs and emotional well-being.

C. The child’s blood values remain outside of normal limits despite treatment.

D. The child experiences significant fluid retention and limited urinary output.

Answer 77

B. The family is able to manage the child’s nutritional needs and emotional well-being.

Rationale: Successful nursing care is reflected by the family’s ability to manage both the child’s physical needs (e.g., nutrition) and emotional needs.

Question 78

Which outcome should the nurse prioritize when evaluating the effectiveness of the child’s chemotherapy treatment plan?

A. Prevention of infection and secondary complications.

B. The child develops a strong support network among peers.

C. The child maintains a consistent weight gain throughout treatment.

D. The child avoids all medications and treatments to reduce side effects.

Answer 78

A. Prevention of infection and secondary complications.

Rationale: Preventing infection and secondary complications is critical to the success of chemotherapy and the child’s overall health during treatment.

Question 79

The parents of a child undergoing chemotherapy for leukemia express concern about their ability to handle the stress of their child’s illness. Which nursing intervention is most appropriate to assist the family in adapting to the chronic illness?

A. Refer the parents to a support group and provide psychosocial resources.

B. Advise the parents to focus solely on the child’s physical health needs.

C. Recommend limiting the parents’ social interactions to reduce stress.

D. Encourage the family to avoid discussing the child’s illness to prevent feelings of sadness.

Answer 79

A. Refer the parents to a support group and provide psychosocial resources.

Rationale: Referring the parents to support groups and providing psychosocial resources help the family adapt and cope with the emotional challenges of managing a chronic illness.

Question 80

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

Answer 80

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

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.

Question 81

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 doesn’t affect the sibling.
3. Unexpected; the cancer is easily treated.
4. Normal; the sibling is affected too, and anger and guilt are expected feelings.

Answer 81

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

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.

Question 82

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

Answer 82

2. Leukemia

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.

Question 83

A child diagnosed with cancer is prescribed chemotherapy. The latest lab value indicates the WBC 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)

Answer 83

1. Filgrastim (Neupogen)

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 RBC production.

Question 84

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

Answer 84

3. Before chemotherapy administration as a prophylactic measure

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.

Question 85

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.

Response 1 Administer the antibiotics.
Response 2 Administer the acetaminophen (Tylenol). Response 3 Obtain the cultures.
Response 4 Ensure the child has bed rest.

Answer 85

1. Response 2 Administer the acetaminophen (Tylenol).
2. Response 3 Obtain the cultures.
3. Response 1 Administer the antibiotics.
4. Response 4 Ensure the child has bed rest.

Question 86

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?
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.

Answer 86

1. Monitor complete blood count (CBC).
2. Document intake and output.
3. Observe for behavioral changes.

Question 87

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?
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

Answer 87

1. Developing other cancers
2. Recommending regular office visits
3. Providing educational and psychosocial support

Question 88

A nurse is assessing a child who has leukemia. Which of the following should the nurse expect to find? (SATA)

A. hypothermia
B. anorexia
C. petechiae
D. erythema
E. unsteady gait

Answer 88

B. anorexia
C. petechiae
E. unsteady gait

Question 89

A nurse is planning care for an infant who is scheduled to have a lumbar puncture. Which of the following actions should the nurse include in the plan of care?

a. cleanse the thoracic area of the infant’s back with antiseptic solution

b. apply a eutectic mixture of local anesthetic cream just before the procedure begins

c. restrain the infant during the procedure to prevent movement

d. position the infant with his head extended and chin raised

Answer 89

c. restrain the infant during the procedure to prevent movement