The Child with Cancer Flashcards
As part of the diagnostic evaluation of a child with cancer, biopsies are important for staging. What statement explains what staging means?
a.
Extent of the disease at the time of diagnosis
b.
Rate normal cells are being replaced by cancer cells
c.
Biologic characteristics of the tumor or lymph nodes
d.
Abnormal, unrestricted growth of cancer cells producing organ damage
ANS: A
Staging is a description of the extent of the disease at the time of diagnosis. Staging criteria exist for most tumors. The stage usually relates directly to the prognosis; the higher the stage, the poorer the prognosis. The rate that normal cells are being replaced by cancer cells is not a definition of staging. Classification of the tumor refers to the biologic characteristics of the tumor or lymph nodes. Abnormal, unrestricted growth of cancer cells producing organ damage describes how cancer cells grow and can cause damage to an organ.
A school-age child with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time. What is the most appropriate nursing action to prevent or minimize these reactions with subsequent treatments?
a.
Administer the chemotherapy between meals.
b.
Give an antiemetic before chemotherapy begins.
c.
Have the child bring favorite foods for snacks.
d.
Keep the child NPO (nothing by mouth) until nausea and vomiting subside.
ANS: B
The most beneficial regimen to minimize nausea and vomiting associated with chemotherapy is to administer a 5-hydroxytryptamine-3 receptor antagonist (e.g., ondansetron) before the chemotherapy is begun. The goal is to prevent anticipatory signs and symptoms. The child will experience nausea with chemotherapy whether or not food is present in the stomach. Because some children develop aversions to foods eaten during chemotherapy, refraining from offering favorite foods is advised. Keeping the child NPO until nausea and vomiting subside will help with this episode, but the child will have discomfort and be at risk for dehydration.
The nurse is preparing a child for possible alopecia from chemotherapy. What information should the nurse include?
a.
Wearing hats or scarves is preferable to a wig.
b.
Expose head to sunlight to stimulate hair regrowth.
c.
Hair may have a slightly different color or texture when it regrows.
d.
Regrowth of hair usually begins 12 months after chemotherapy ends.
ANS: C
Alopecia is a side effect of certain chemotherapeutic agents and cranial irradiation. When the hair regrows, it may be of a different color or texture. Children should choose the head covering they prefer. A wig should be selected similar to the child’s own hairstyle and color before the hair loss. The head should be protected from sunlight to avoid sunburn. The hair usually grows back within 3 to 6 months after the cessation of treatment.
What is an important priority in dealing with the child suspected of having Wilms tumor?
a.
Intervening to minimize bleeding
b.
Monitoring temperature for infection
c.
Ensuring the abdomen is protected from palpation
d.
Teaching parents how to manage the parenteral nutrition
ANS: C
Wilms tumor, or nephroblastoma, is the most common malignant renal and intraabdominal tumor of childhood. The abdomen is protected, and palpation is avoided. Careful handling and bathing are essential to prevent trauma to the tumor site. Before chemotherapy, the child is not myelosuppressed. Bleeding is not usually a risk. Infection is a concern after surgery and during chemotherapy, not before surgery. Parenteral therapy is not indicated before surgery.
Essential postoperative nursing management of a child after removal of a brain tumor includes which nursing care?
a.
Turning and positioning every 2 hours
b.
Measuring all fluid intake and output
c.
Changing the dressing when it becomes soiled
d.
Using maximum lighting to ensure accurate observations
ANS: B
After brain surgery, cerebral edema is a risk. Careful monitoring is essential. All fluids, including intravenous antibiotics, are included in the intake. Turning and positioning depend on the surgical procedure. When large tumors are removed, the child is usually not positioned on the operative side. The dressing is not changed. It is reinforced with gauze after the amount of drainage is marked and estimated. A quiet, dimly lit environment is optimum to decrease stimulation and relieve discomfort such as headaches.
What chemotherapeutic agent can cause an anaphylactic reaction?
a.
Prednisone (Deltasone)
b.
Vincristine (Oncovin)
c.
L-Asparaginase (Elspar)
d.
Methotrexate (Trexall)
ANS: C
A potentially fatal complication is anaphylaxis, especially from L-asparaginase, bleomycin, cisplatin, and etoposide (VP-16).
A child has been diagnosed with a Wilms tumor. What should preoperative nursing care include?
a.
Careful bathing and handling
b.
Monitoring of behavioral status
c.
Maintenance of strict isolation
d.
Administration of packed red blood cells
ANS: A
Careful bathing and handling are important in preventing trauma to the Wilms tumor site.
What are the most common clinical manifestations of brain tumors in children?
a.
Headaches and vomiting
b.
Blurred vision and ataxia
c.
Hydrocephalus and clumsy gait
d.
Fever and poor fine motor control
ANS: A
Headaches, especially on awakening, and vomiting that is not related to feeding are the most common clinical manifestations of brain tumors in children. Diplopia (double vision), not blurred vision, can be a presenting sign of brainstem glioma. Ataxia is a clinical manifestation of brain tumors, but headaches and vomiting are the most common. Hydrocephalus can be a presenting sign in infants when the sutures have not closed. Children at this age are usually not walking steadily. Poor fine motor coordination may be a presenting sign of astrocytoma, but headaches and vomiting are the most common presenting signs of brain tumors.
A 5-year-old child is being prepared for surgery to remove a brain tumor. Preparation for surgery should be based on which information?
a.
Removal of the tumor will stop the various signs and symptoms.
b.
Usually the postoperative dressing covers the entire scalp.
c.
He is not old enough to be concerned about his head being shaved.
d.
He is not old enough to understand the significance of the brain.
The child should be told what he will look and feel like after surgery. This includes the anticipated size of the dressing. The nurse can demonstrate on a doll the expected size and shape of the dressing. Some of the symptoms may be alleviated by removal of the tumor, but postsurgical headaches and cerebellar symptoms such as ataxia may be aggravated. Children should be prepared for the loss of their hair, and it should be removed in a sensitive, positive manner if the child is awake. Children at this age have poorly defined body boundaries and little knowledge of internal organs. Intrusive experiences are frightening, especially those that disrupt the integrity of the skin.
A young child with leukemia has anorexia and severe stomatitis. What approach should the nurse suggest that the parents try?
a.
Relax any eating pressures.
b.
Firmly insist that the child eat normally.
c.
Serve foods that are either hot or cold.
d.
Provide only liquids because chewing is painful.
ANS: A
A multifaceted approach is necessary for children with severe stomatitis and anorexia. First, the parents should relax eating pressures. The nurse should suggest that the parents try soft, bland foods; normal saline or bicarbonate mouthwashes; and local anesthetics. Insisting that the child eat normally is not suggested. For some children, not eating may be a way to maintain some control. This can set the child and caregiver in opposition to each other. Hot and cold foods can be painful on ulcerated mucosal membranes. Substitution of high-calorie foods that the child likes and can eat should be used.
The nurse is caring for a child receiving chemotherapy for leukemia. The child’s granulocyte count is 600/mm3 and platelet count is 45,000/mm3. What oral care should the nurse recommend for this child?
a.
Rinsing mouth with water
b.
Daily toothbrushing and flossing
c.
Lemon glycerin swabs for cleansing
d.
Wiping teeth with moistened gauze or Toothettes
ANS: B
Oral care is essential for children receiving chemotherapy to prevent infections and other complications. When the child’s granulocyte count is above 500/mm3 and platelet count is above 40,000/mm3, daily brushing and flossing are recommended. Rinsing the mouth with water is not effective for oral hygiene. Lemon glycerin swabs are avoided because they have a drying effect on the mucous membranes, and the lemon may irritate eroded tissue and decay the child’s teeth. Wiping teeth with moistened gauze or Toothettes is recommended when the child’s granulocyte count is below 500/mm3 and platelet count is below 40,000/mm3.
The nurse is caring for a child with retinoblastoma that was treated with an enucleation. What interventions should the nurse plan for care of an eye socket after enucleation? (Select all that apply.)
a.
Clean the prosthesis.
b.
Change the eye pad daily.
c.
Keep the opposite eye covered initially.
d.
Irrigate the socket daily with a prescribed solution.
e.
Apply a prescribed antibiotic ointment after irrigation.
ANS: B, D, E
Care of the socket is minimal and easily accomplished. The wound itself is clean and has little or no drainage. If an antibiotic ointment is prescribed, it is applied in a thin line on the surface of the tissues of the socket. To cleanse the site, an irrigating solution may be ordered and is instilled daily or more frequently if necessary before application of the antibiotic ointment. The dressing consists of an eye pad changed daily. The prosthesis is not placed until the socket has healed. The opposite eye is not covered.
The parents of a child with cancer tell the nurse that a bone marrow transplant (BMT) may be necessary. What information should the nurse recognize as important when discussing this with the family?
a.
BMT should be done at the time of diagnosis.
b.
Parents and siblings of the child have a 25% chance of being a suitable donor.
c.
If BMT fails, chemotherapy or radiotherapy will need to be continued.
d.
Finding a suitable donor involves matching antigens from the human leukocyte antigen (HLA) system.
ANS: D
The most successful BMTs come from suitable HLA-matched donors. The timing of a BMT depends on the disease process involved. It usually follows intensive high-dose chemotherapy or radiotherapy. Usually, parents only share approximately 50% of the genetic material with their children. A one in four chance exists that two siblings will have two identical haplotypes and will be identically matched at the HLA loci. The decision to continue chemotherapy or radiotherapy if BMT fails is not appropriate to discuss with the parents when planning the BMT. That decision will be made later.
A child with cancer being treated with chemotherapy is receiving a platelet transfusion. The nurse understands that the transfused platelets should survive the body for how many days?
a.
1 to 3 days
b.
4 to 6 days
c.
7 to 9 days
d.
10 to 12 days
ANS: A
Transfused platelets generally survive in the body for 1 to 3 days. The peak effect is reached in about 1 hour and decreased by half in 24 hours.
The nurse should teach the family that which residual disabilities can occur for a child being treated for a brain tumor? (Select all that apply.)
a.
Ataxia
b.
Anorexia
c.
Dysphagia
d.
Sensory deficits
e.
Crania nerve palsies
ANS: A, C, D, E
Even with children who are long-term survivors after treatment for a brain tumor, residual disabilities, such as short stature, cranial nerve palsies, sensory defects, motor abnormalities (especially ataxia), intellectual deficits, dysphagia, dysgraphia, and behavioral problems, may occur. Anorexia is not a residual disability.
A child has an absolute neutrophil count (ANC) of 500/mm3. The nurse should expect to be administering which prescribed treatment?
a.
Platelets
b.
Packed red blood cells
c.
Zofran (ondansetron)
d.
G-CSF (Neupogen) daily
ANS: D
G-CSF (filgrastim [Neupogen], pegfilgrastim [Neulasta]) directs granulocyte development and can decrease the duration of neutropenia following immunosuppressive therapy. G-CSF is discontinued when the ANC surpasses 10,000/mm3.
What immunization should not be given to a child receiving chemotherapy for cancer?
a.
Tetanus vaccine
b.
Inactivated poliovirus vaccine
c.
Diphtheria, pertussis, tetanus (DPT)
d.
Measles, mumps, rubella (MMR)
ANS: D
The vaccine used for MMR is a live virus and can cause serious disease in immunocompromised children. The tetanus vaccine, inactivated poliovirus vaccine, and DPT are not live vaccines and can be given to immunosuppressed children. The immune response is likely to be suboptimum, so delaying vaccination is usually recommended.
What is a common clinical manifestation of Hodgkin disease?
a.
Petechiae
b.
Bone and joint pain
c.
Painful, enlarged lymph nodes
d.
Nontender enlargement of lymph nodes
ANS: D
Asymptomatic, enlarged cervical or supraclavicular lymphadenopathy is the most common presentation of Hodgkin disease. Petechiae are usually associated with leukemia. Bone and joint pain are not likely in Hodgkin disease. The enlarged nodes are rarely painful.
