Chapter 14: Cancer in Children   MULTIPLE CHOICE   1.      What congenital malformation is commonly linked to acute leukemia in children? a. Down syndrome c. Retinoblastoma b. Wilms tumor d. Neuroblastoma ANS:                                 

Chapter 14: Cancer in Children MULTIPLE CHOICE 1. What congenital malformation is commonly linked to acute leukemia in children? a. Down syndrome c. Retinoblastoma b. Wilms tumor d. Neuroblastoma ANS: Trisomy 21 (Down syndrome) is the most common genetic defect linked to the development of acute leukemia. Children with Down syndrome have a 10- to 20-fold increased risk of developing acute lymphoblastic and myelogenous leukemia and a higher risk for developing acute megakaryocytic leukemia. No current research supports a link between the other stated congenital malformations and acute leukemia. PTS: 1 REF: Page 444 2. When are childhood cancers most often diagnosed? a. During infancy c. After diagnosis of a chronic illness b. At peak times of physical growth d. After an acute illness ANS: Childhood cancers are most often diagnosed during peak times of physical growth. No current research supports the other options. PTS: 1 REF: Page 443 3. Prenatal exposure to diethylstilbestrol (DES) can result in which type of cancer? a. Breast cancer c. Vaginal cancer b. Leukemia d. Lymphoma ANS: DES has been identified as a transplacental chemical carcinogen; a small percentage of the daughters of women who took DES during pregnancy developed adenocarcinomas of the vagina. No current research supports a link between the drug and other cancers. PTS: 1 REF: Page 445 4. Currently, what percentage of children with cancer can be cured? a. 40% c. 60% b. 50% d. 80% ANS: Currently, more than 80% of children diagnosed with cancer are cured. PTS: 1 REF: Page 445 5. Most childhood cancers arise from the: a. Epithelium c. Embryologic ectodermal layer b. Mesodermal germ layer d. Viscera ANS: Most childhood cancers originate from the mesodermal germ layer that gives rise to connective tissue, bone, cartilage, muscle, blood, blood vessels, gonads, kidney, and the lymphatic system. The other options are not common sites from which cancers originate. PTS: 1 REF: Page 443 6. Which form of cancer is linked to congenital malformation syndromes? a. Wilms tumor c. Osteosarcoma b. Retinoblastoma d. Rhabdomyosarcoma ANS: Wilms tumors are linked with other genetically linked childhood cancers. It is the only form among the available options that is associated with congenital malformation syndromes. PTS: 1 REF: Page 443 | Table 14-1 7. Research data support a carcinogenic relationship in children resulting from exposure to which virus? a. Herpes simplex virus c. Varicella zoster virus b. Influenza d. Epstein-Barr virus ANS: The strongest association between viruses and the development of cancer in children has been the Epstein-Barr virus (EBV), Burkitt lymphoma, nasopharyngeal carcinoma, and Hodgkin disease. No current research supports a link between the remaining options and childhood cancer. PTS: 1 REF: Page 445 8. A child diagnosed with acquired immunodeficiency syndrome (AIDS) has an increased risk of developing: a. Non-Hodgkin lymphoma c. Epstein-Barr b. Retinoblastoma d. Leukemia ANS: Children with AIDS have an increased risk of developing non-Hodgkin lymphoma and Kaposi sarcoma. Leukemia is linked to retinoblastoma. Epstein-Barr has been linked to the development of some cancers, whereas no known link has been found between AIDS and the development of leukemia. PTS: 1 REF: Page 445 9. Which intervention has the greatest affect on a child’s mortality rate when diagnosed with cancer? a. Age at the time of diagnosis b. Participation in clinical trials c. Proximity to a major cancer treatment center d. Parental involvement in the treatment planning ANS: Mortality rates have significantly declined in the past 40 years largely as a result of advances in treatment and participation in clinical trials. Although important, the other options are not believed to have an affect on the decline of the mortality rate of childhood cancer. PTS: 1 REF: Page 445 10. Which statement is likely true regarding children being treated for cancer with radiation therapy? a. They will most likely have a successful remission of tumor growth. b. They seldom require follow-up maintenance treatments. c. They are prone to experience severe developmental delays. d. They are at increased risk for developing adult cancers. ANS: Although the need exists for long-term studies, research has shown a correlation between radiation-induced malignancies from radiotherapy (as in cancer treatment) or radiation exposure from diagnostic imaging; both have shown to increase the risk of developing cancer during adulthood. The other options are not necessarily true regarding the outcomes of radiation therapy for childhood cancers. PTS: 1 REF: Page 445 11. How should the nurse reply when a parent questions why a computed tomographic (CT) scan of the head was not ordered for their 5-year-old child after a minor fall? a. Physicians are cautious about ordering CT scan on children younger than 10 years of age. b. CT scans are seldom conclusive when used to diagnosis head injuries in young children. c. The child’s symptoms will determine whether a CT scan is necessary and worth the expense. d. Research suggests that repeated CT scans can increase the risk of developing brain cancer. ANS: Findings from a recent study of 176,587 children suggest that those who have two or three CT scans of the head before the age of 22 years are three times more likely to develop brain cancer as those in the general population, and the risk of developing leukemia is three times as great in those who received five to ten CT scans. The other options do not represent the logic behind not ordering a CT scan in relationship to minor head trauma. PTS: 1 REF: Page 445 | What's New box MULTIPLE RESPONSE 12. Childhood exposure to which risk factors increases the susceptibility for developing cancers? (Select all that apply.) a. Low birth weight b. Chemotherapy c. Ionizing radiation d. Cigarette smoke e. Hodgkin disease ANS: , C, E Childhood exposure to ionizing radiation, drugs, or existing cancer-causing viruses has been associated with the risk of developing cancer. Although unhealthy, no current research identifies cigarette smoke or low birth weight as risk factors for childhood cancer. PTS: 1 REF: Page 445 | Table 14-3 13. Which statement is true concerning the difference between adult and childhood cancers? (Select all that apply.) a. Numerous differences exist between these two categories of cancer. b. Childhood cancers are far less likely to be associated with genetic mutations. c. Environmental risks are strongly associated with childhood cancers. d. Exposure to pesticides is a minor risk for the development of adult cancers. e. Maternal exposure to carcinogenic substances presents little risk to the fetus. ANS: , B Overall, cancers in children are very different than adult cancers and are associated with far fewer genetic mutations. Research does not support the other options. PTS: 1 REF: Page 442 | Page 444 | What's New box 14. Most childhood cancers originate from the mesodermal germ layer that ultimately produces which of the following? (Select all that apply.) a. Connective tissue b. Digestive system c. Muscles d. Kidneys e. Blood ANS: , C, D, E Most childhood cancers originate from the mesodermal germ layer, which gives rise to connective tissue, bone cartilage, muscle, blood, blood vessels, gonads, kidney, and the lymphatic system. Cancers of the digestive tract do not originate in the mesodermal germ layer. PTS: 1 REF: Page 443 15. Which statements are true regarding cancers that develop in children? (Select all that apply.) a. Childhood cancers tend to be fast growing. b. Childhood cancers are diagnosed during growth spurts. c. Childhood cancer generally metastasizes by the time of diagnosis. d. Childhood cancer is typically at low risk for aggressive metastasis. e. Childhood cancers respond well to standardized treatment modalities. ANS: , B, C Childhood cancers are most often diagnosed during peak times of physical growth. In general, they are extremely fast growing, with 80% having distant spread (metastases) at diagnosis. The other options are not true regarding childhood cancers. PTS: 1 REF: Page 443 16. The nurse is preparing a discussion on cancer and its occurrence among college-aged students. Which cancers will the nurse include in the discussion? (Select all that apply.) a. Colorectal b. Testicular c. Thyroid d. Breast e. Lung ANS: , B, C, D The most common cancers among the adolescent and young adult population (15 to 39 years of age) are Hodgkin lymphoma, leukemia, germ-cell tumors (particularly testicular), central nervous system tumors, non-Hodgkin lymphoma, thyroid cancer, melanoma, sarcomas, and breast, cervical, liver, thyroid and colorectal cancers. Lung cancer generally develops after chronic inhalation of nicotine-containing products. PTS: 1 REF: Page 442 Chapter 15: Structure and Function of the Neurologic System MULTIPLE CHOICE 1. Which pathway carries sensory information toward the central nervous system (CNS)? a. Ascending c. Somatic b. Descending d. Efferent ANS: Peripheral nerve pathways can be afferent (ascending) pathways that carry sensory impulses toward the CNS. The remaining options do not carry sensory information to the CNS. PTS: 1 REF: Page 448 2. Which type of axon transmits a nerve impulse at the highest rate? a. Large nonmyelinated c. Small nonmyelinated b. Large myelinated d. Small myelinated ANS: If the myelin layer is tightly wrapped many times around the axon and is forming the nodes of Ranvier, then conduction velocity increases and the neuron is referred to as myelinated. The increased diameter of the myelinated axons allows for the transmission of impulses at a faster rate. The other options do not affect nervous impulse transmission rates. PTS: 1 REF: Pages 448-450 3. Which nerves are capable of regeneration? a. Nerves within the brain and spinal cord b. Peripheral nerves that are cut or severed c. Myelinated nerves in the peripheral nervous system d. Unmyelinated nerves of the peripheral nervous system ANS: Nerve regeneration is limited to only myelinated fibers and generally occurs only in the peripheral nervous system. PTS: 1 REF: Pages 450-451 4. The neurotransmitter, norepinephrine, is secreted in the: a. Somatic nervous system c. Sympathetic postganglion b. Parasympathetic preganglion d. Parasympathetic postganglion ANS: Most postganglionic sympathetic fibers release norepinephrine (adrenaline). The remaining options do not reflect the correct site of norepinephrine secretion. PTS: 1 REF: Pages 473-474 5. Both oligodendroglia and Schwann cells share the ability to: a. Form a myelin sheath c. Transport nutrients b. Remove cellular debris d. Line the ventricles ANS: The function of oligodendroglia (oligodendrocytes) is to deposit myelin within the central nervous system (CNS). Oligodendroglia are the CNS counterpart of Schwann cells. The remaining options are not reflective of the common function of these structures. PTS: 1 REF: Pages 449-450 6. During a synapse, what change occurs after the neurotransmitter binds to the receptor? a. The permeability of the presynaptic neuron changes; consequently, its membrane potential is changed as well. b. The permeability of the postsynaptic neuron changes; consequently, its membrane potential is changed as well. c. The postsynaptic cell prevents any change in permeability and destroys the action potential. d. The presynaptic cell synthesizes and secretes additional neurotransmitters. ANS: The binding of the neurotransmitter at the receptor site changes the permeability of the postsynaptic neuron and, consequently, its membrane potential. The remaining options do not accurately describe the occurrence. PTS: 1 REF: Pages 452-453 7. What name is given to a large network of neurons within the brainstem that is essential for maintaining wakefulness? a. Midbrain c. Medulla oblongata b. Reticular activating system d. Pons ANS: The reticular activating system is essential for maintaining wakefulness. The remaining options are not essential to this function. PTS: 1 REF: Page 454 8. Thought and goal-oriented behaviors are functions of which area of the brain? a. Cerebellum c. Prefrontal lobe b. Limbic system d. Occipital lobe ANS: The prefrontal area is responsible for goal-oriented behavior (i.e., ability to concentrate), short-term or recall memory, and the elaboration of thought and inhibition on the limbic (emotional) areas of the CNS. The remaining options are not involved in these functions. PTS: 1 REF: Page 456 9. The region responsible for the motor aspects of speech is located in the: a. Wernicke area in the temporal lobe c. Wronka area in the parietal lobe b. Broca area in the frontal lobe d. Barlow area in the occipital lobe ANS: Broca speech area is the only region responsible for the motor aspects of speech. PTS: 1 REF: Page 457 10. Parkinson and Huntington diseases are associated with defects in which area of the brain? a. Thalamus c. Cerebellum b. Medulla oblongata d. Basal ganglia ANS: Parkinson and Huntington diseases are conditions associated with defects of the basal ganglia. No current research supports the role of any of the other options in these diseases. PTS: 1 REF: Page 457 11. Maintenance of a constant internal environment and the implementation of behavioral patterns are main functions of which area of the brain? a. Thalamus c. Subthalamus b. Epithalamus d. Hypothalamus ANS: Hypothalamic function falls into two major areas: (1) maintenance of a constant internal environment, and (2) implementation of behavioral patterns. The remaining options do not address these functions. PTS: 1 REF: Page 459 12. The ability of the eyes to track moving objects through a visual field is primarily a function of which colliculi? a. Inferior c. Mid b. Superior d. Posterior ANS: The superior colliculi are involved with voluntary and involuntary visual motor movements (e.g., the ability of the eyes to track moving objects in the visual field). Tracking moving objects is not the primary function of the remaining options. PTS: 1 REF: Page 459 13. What parts of the brain mediate the expression of affect, both emotional and behavioral states? a. Hypothalamus and subthalamus c. Limbic system and prefrontal cortex b. Parietal and frontal lobes d. Basal ganglia and medulla oblongata ANS: Extensive connections with the limbic system and prefrontal cortex mediate the expression of affect, both emotional and behavioral states. The remaining options are not involved in these expressions. PTS: 1 REF: Page 457 14. Reflex activities concerned with heart rate, blood pressure, respirations, sneezing, swallowing, and coughing are controlled by which area of the brain? a. Pons c. Cerebellum b. Midbrain d. Medulla oblongata ANS: The medulla oblongata makes up the myelencephalon and is the lowest portion of the brainstem. Reflex activities, such as heart rate, respiration, blood pressure, coughing, sneezing, swallowing, and vomiting, are controlled only in this area. PTS: 1 REF: Page 460 15. From which part of the midbrain do cranial nerves V to VIII emerge? a. Midbrain c. Medulla oblongata b. Pons d. Lateral colliculi ANS: The nuclei of cranial nerves V through VIII (see Table 15-6 for discussion) are located only in the pons. PTS: 1 REF: Pages 459-460 16. From which part of the midbrain do cranial nerves IX to XII emerge? a. Midbrain c. Medulla oblongata b. Pons d. Lateral colliculi ANS: The nuclei of cranial nerves IX through XII (see Table 15-6 for discussion) are located only in the medulla oblongata. PTS: 1 REF: Page 460 17. Which area of the brain assumes the responsibility for conscious and unconscious muscle synergy and for maintaining balance and posture? a. Cerebrum c. Diencephalon b. Cerebellum d. Brainstem ANS: The cerebellum is responsible for conscious and unconscious muscle synergy and for maintaining balance and posture. This role is not assumed by any of the remaining options. PTS: 1 REF: Page 459 18. Which statement is true regarding upper motor neurons? a. Upper motor neurons directly influence muscles. b. They modify spinal reflex arcs. c. Upper motor neurons are located in the gray matter of the spinal cord. d. They extend their dendritic processes out of the CNS. ANS: Upper motor neurons (i.e., corticospinal tract) are the classification of motor pathways completely contained within the CNS. Their primary roles include directing, influencing, and modifying reflex arcs, lower-level control centers, and motor and some sensory neurons. The r