Chapter 48 The Child with Cancer

Chapter 48  The Child with Cancer

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. The nurse notes that a child’s gums bleed easily and that the child has bruising and petechiae

on his extremities. What laboratory values are consistent with these symptoms?
a. Platelet count of 19,000/mm3
b. Prothrombin time of 11 to 15 seconds
c. Hematocrit of 34
d. Leukocyte count of 14,000/mm3

ANS: A
The normal platelet count is 150,000 to 400,000/mm3. This finding is very low, indicating an
increased bleeding potential. The child should be monitored closely for signs of bleeding. The
prothrombin time of 11 to 15 seconds is within normal limits. The normal hematocrit is 35 to
45, and although this finding is low, it would not create the symptoms presented. This value
indicates the probable presence of infection, but it is not a reflection of bleeding tendency.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 1151 | p. 1144 | Box 48.1 OBJ: Nursing Process: Assessment
MSC: Client Needs: Physiologic Integrity

2. The nurse understands that the types of precautions needed for children receiving

chemotherapy are based on which action of chemotherapeutic agents?
a. Gastrointestinal upset
b. Bone marrow suppression
c. Decreased creatinine level
d. Alopecia

ANS: B
Chemotherapy agents cause bone marrow suppression, which creates the need to institute
precautions related to reduced white blood cell, red blood cell, and platelet counts. These
precautions focus on preventing infection and bleeding. Although gastrointestinal upset may
be an adverse effect of chemotherapy, it is not caused by all chemotherapeutic agents. No
special precautions are instituted for gastrointestinal upset. A decreased creatinine level is
consistent with renal pathologic conditions, not chemotherapy. Not all chemotherapeutic
agents cause alopecia. No precautions are taken to prevent alopecia.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 1143 | p. 1145 OBJ: Nursing Process: Assessment
MSC: Client Needs: Safe and Effective Care Environment

3. Parents of a child with acute lymphoblastic leukemia (ALL) ask about their child’s prognosis.

The nurse should base the response on the knowledge that
a. leukemia is a fatal disease, although chemotherapy provides increasingly longer

periods of remission.
b. research to find a cure for childhood cancers is very active.
c. the majority of children go into remission and remain symptom free when

treatment is completed.

d. it usually takes several months of chemotherapy to achieve a remission.

ANS: C
Children diagnosed with the most common form of leukemia, ALL, can almost always
achieve remission, with a 5-year disease-free survival rate approaching 85%. With the
majority of children surviving 5 years or longer, it is inappropriate to refer to leukemia as a
fatal disease. Telling parents about current research to answer their question does not address
their concern. About 95% of children achieve remission within the first month of
chemotherapy.

PTS: 1 DIF: Cognitive Level: Comprehension/Understanding
REF: p. 1148 OBJ: Nursing Process: Implementation
MSC: Client Needs: Physiologic Integrity

4. Hematopoietic stem cell transplantation (HSCT) is the standard treatment for a child in his or

her first remission with what cancer?
a. Acute lymphocytic leukemias
b. Non-Hodgkin lymphoma
c. Wilms’ tumor
d. Acute myeloblastic leukemia (AML)

ANS: D
HSCT is often used interchangeably with bone marrow transplantation and is currently
standard treatment for children in their first remission with AML. Transplantation is standard
treatment for a specific type of ALL (Philadelphia chromosome positive). Standard treatment
for non-Hodgkin lymphoma is chemotherapy. Bone marrow transplantation is used to treat
non-Hodgkin lymphoma that is resistant to conventional chemotherapy and radiation. The
treatment for Wilms’ tumor consists of surgery and chemotherapy alone or in combination
with radiation therapy.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 1147 OBJ: Nursing Process: Assessment
MSC: Client Needs: Physiologic Integrity

5. A child with a history of fever of unknown origin, excessive bruising, lymphadenopathy,

anemia, and fatigue is exhibiting symptoms most suggestive of which of the following?
a. Ewing sarcoma
b. Wilms’ tumor
c. Neuroblastoma
d. Leukemia

ANS: D
These symptoms reflect bone marrow failure and organ infiltration, which occur in leukemia.
Symptoms of Ewing sarcoma involve pain and soft tissue swelling around the affected bone.
Wilms’ tumor usually manifests as an abdominal mass with abdominal pain and may include
renal symptoms, such as hematuria, hypertension, and anemia. Neuroblastoma manifests
primarily as an abdominal, chest, bone, or joint mass. Symptoms are dependent on the extent
and involvement of the tumor.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 1149 OBJ: Nursing Process: Assessment
MSC: Client Needs: Physiologic Integrity