1. A parent brings a child to the clinic and reports that the child is reluctant to walk and has
a new limp. The parent also reports that the child seems lethargic and tired all the time.
The nurse notes that the child appears pale. Which other finding would warrant
immediate notification of the health-care provider?
a. Difficulty staying asleep at night
b. Left-sided abdominal enlargement
c. Polyphagia and polydipsia
d. Swelling of the legs and feet
ANS: B
Chapter: Chapter 26 Caring for the Child With Cancer
Objective: #6. Examine the medical emergencies that occur in children with common
child- hood cancers.
Page: 875
Heading: Signs and Symptoms
Integrated Processes: Nursing Process: Assessment
Client Need: Physiological Integrity: Physiological Adaptation
Cognitive Level: Application [Applying]
Concept: Assessment
Difficulty: Moderate
Feedback
A. Difficulty staying asleep at night is vague and could be related to a number of
causes, both physical and behavioral.
B. This child has some manifestations of acute lymphocytic leukemia (ALL).
Left-sided abdominal enlargement could be indicative of splenomegaly, which
is another manifestation of this disease. The nurse should report these findings
immediately.
C. Polydipsia and polyphagia are two of the three classic signs of diabetes.
D. Swelling of the legs and feet would not require notification of the health-care
provider.
2. A child is admitted and scheduled to receive intravenous asparaginase (Elspar). Which
action by the nurse is most important when administering this medication?
a. Arranging an outpatient hearing test
b. Having emergency drugs on hand
c. Monitoring the child’s intake and output
d. Providing antiemetic drugs as needed
, ANS: B
Chapter: Chapter 26 Caring for the Child With Cancer
Objective: #4. Explore diagnostic and laboratory testing, and medications for common
child- hood cancers.
Page: 888
Heading: Table 26-2 Chemotherapeutic Agents and Common Cancer Drugs
Integrated Processes: Nursing Process: Implementation
Client Need: Physiological
Integrity: Pharmacological and Parenteral Therapies
Cognitive Level: Application [Applying]
Concept: Assessment; Medication
Difficulty: Moderate
Feedback
A. Ototoxicity can be caused by carboplatin (Paraplatin).
B. Anaphylaxis is a possible side effect of this drug. Emergency medications
should be readily available.
C. Monitoring intake and output is important for any child on IV therapy.
D. Antiemetic drugs are important for any child receiving chemotherapy.
3. A neutropenic child is admitted to the hospital and placed in protective isolation. Which
instruction does the nurse give the family to help maintain a safe environment for the
child?
a. Do not let the child have chewing gum
b. Flowers, plants, and produce are not allowed
c. The child can only have one visitor at a time
d. Toys and items from home cannot be brought in
ANS: B
Chapter: Chapter 26 Caring for the Child With Cancer
Objective: #7. Develop teaching plans and discharge criteria, including the
psychological effect for parents whose children have common cancers.
Page: 895
Heading: Neutropenic Precautions
Integrated Processes: Teaching and Learning
Client Need: Safe and Effective Care Environment: Safety and Infection Control
Cognitive Level: Application [Applying]
Concept: Assessment; Nursing Roles
Difficulty: Moderate
Feedback
A. It is not necessary to warn against chewing gum.
B. The neutropenic child should not have fresh flowers, plants, fruits, or
, vegetables because they can harbor infectious microorganisms.
C. This patient can have more than one visitor at a time.
D. Toys and items from home can be brought in.
4. A 7-year-old child presents to the emergency department, where the parent reports a 3-
week history of pale skin, extreme fatigue, and dizziness. Which laboratory value would
the nurse correlate with the patient’s current condition?
a. Hematocrit: 33%
b. Hemoglobin: 13.2 g/dL
c. Red blood cell count: 2.8/mm3
d. White blood cell count: 12.3/mm3
ANS: C
Chapter: Chapter 26 Caring for the Child With Cancer
Objective: #4. Explore diagnostic and laboratory testing, and medications for common
childhood cancers.
Page: 894
Heading: Anemia
Integrated Processes: Nursing Process: Implementation
Client Need: Physiological
Integrity: Reduction of Risk Potential
Cognitive Level: Analysis [Analyzing]
Concept: Assessment; Critical Thinking
Difficulty: Difficult
Feedback
A. A hematocrit value of 33% is normal.
B. A hemoglobin value of 13.2 g/dL is normal.
C. For a child of this age, a normal RBC count is 4–5.2/mm3. Low RBCs can lead
to pallor, fatigue, headaches, and dizziness as tissues are not being oxygenated.
D. A white blood cell count of 12.3/mm3 is normal.
5. A child has been diagnosed with chronic myelogenous leukemia (CML). Which statement
by the nurse to the parents is most appropriate?
a. “Radiation therapy is the standard treatment.”
b. “The prognosis for this disease is extremely poor.”
c. “There are lots of good medications for nausea.”
d. “We need to test siblings for a bone marrow match.”
ANS: D
Chapter: Chapter 26 Caring for the Child With Cancer
Objective: #4. Explore diagnostic and laboratory testing, and medications for common
childhood cancers.
Page: 877
, Heading: Chronic Myelogenous Leukemia
Integrated Processes: Communication and Documentation
Client Need: Physiological Integrity: Physiological Adaptation
Cognitive Level: Application [Applying]
Concept: Assessment
Difficulty: Moderate
Feedback
A. Radiation therapy is not used.
B. Prognosis for CML is good.
C. Although there are many good medications for nausea, this statement is not the
best choice because it is not specific to this child’s condition.
D. The preferred treatment for CML is a bone marrow or stem cell transplant from
a matching sibling, which can be curative in up to 80% of patients.
6. A nurse is caring for a child who has acute lymphocytic leukemia and has been treated
with doxorubicin (Adriamycin). Which assessment finding would the nurse report
immediately?
a. Loss of appetite
b. Low WBC count
c. Peripheral edema
d. Temperature of 100.6°F (38.1°C), once
ANS: C
Chapter: Chapter 26 Caring for the Child With Cancer
Objective: #4. Explore diagnostic and laboratory testing, and medications for common
child- hood cancers.
Page: 888
Heading: Table 26-2 Chemotherapeutic Agents and Common Cancer Drugs
Integrated Processes: Nursing Process: Implementation
Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies
Cognitive Level: Application [Applying]
Concept: Assessment; Medication
Difficulty: Moderate
Feedback
A. Loss of appetite is a common finding for a child on chemotherapy.
B. Low WBC count is a common finding for a child on chemotherapy.
C. Doxorubicin and other anthracycline drugs are known to cause heart damage.
Peripheral edema may signal heart failure and should be reported right away.
D. A single temperature of 100.6°F does not need to be reported.
7. An 8-year-old child has been diagnosed with a brain tumor. Based on knowledge of
childhood cancers, which intervention does the nurse plan to implement when the child is
a new limp. The parent also reports that the child seems lethargic and tired all the time.
The nurse notes that the child appears pale. Which other finding would warrant
immediate notification of the health-care provider?
a. Difficulty staying asleep at night
b. Left-sided abdominal enlargement
c. Polyphagia and polydipsia
d. Swelling of the legs and feet
ANS: B
Chapter: Chapter 26 Caring for the Child With Cancer
Objective: #6. Examine the medical emergencies that occur in children with common
child- hood cancers.
Page: 875
Heading: Signs and Symptoms
Integrated Processes: Nursing Process: Assessment
Client Need: Physiological Integrity: Physiological Adaptation
Cognitive Level: Application [Applying]
Concept: Assessment
Difficulty: Moderate
Feedback
A. Difficulty staying asleep at night is vague and could be related to a number of
causes, both physical and behavioral.
B. This child has some manifestations of acute lymphocytic leukemia (ALL).
Left-sided abdominal enlargement could be indicative of splenomegaly, which
is another manifestation of this disease. The nurse should report these findings
immediately.
C. Polydipsia and polyphagia are two of the three classic signs of diabetes.
D. Swelling of the legs and feet would not require notification of the health-care
provider.
2. A child is admitted and scheduled to receive intravenous asparaginase (Elspar). Which
action by the nurse is most important when administering this medication?
a. Arranging an outpatient hearing test
b. Having emergency drugs on hand
c. Monitoring the child’s intake and output
d. Providing antiemetic drugs as needed
, ANS: B
Chapter: Chapter 26 Caring for the Child With Cancer
Objective: #4. Explore diagnostic and laboratory testing, and medications for common
child- hood cancers.
Page: 888
Heading: Table 26-2 Chemotherapeutic Agents and Common Cancer Drugs
Integrated Processes: Nursing Process: Implementation
Client Need: Physiological
Integrity: Pharmacological and Parenteral Therapies
Cognitive Level: Application [Applying]
Concept: Assessment; Medication
Difficulty: Moderate
Feedback
A. Ototoxicity can be caused by carboplatin (Paraplatin).
B. Anaphylaxis is a possible side effect of this drug. Emergency medications
should be readily available.
C. Monitoring intake and output is important for any child on IV therapy.
D. Antiemetic drugs are important for any child receiving chemotherapy.
3. A neutropenic child is admitted to the hospital and placed in protective isolation. Which
instruction does the nurse give the family to help maintain a safe environment for the
child?
a. Do not let the child have chewing gum
b. Flowers, plants, and produce are not allowed
c. The child can only have one visitor at a time
d. Toys and items from home cannot be brought in
ANS: B
Chapter: Chapter 26 Caring for the Child With Cancer
Objective: #7. Develop teaching plans and discharge criteria, including the
psychological effect for parents whose children have common cancers.
Page: 895
Heading: Neutropenic Precautions
Integrated Processes: Teaching and Learning
Client Need: Safe and Effective Care Environment: Safety and Infection Control
Cognitive Level: Application [Applying]
Concept: Assessment; Nursing Roles
Difficulty: Moderate
Feedback
A. It is not necessary to warn against chewing gum.
B. The neutropenic child should not have fresh flowers, plants, fruits, or
, vegetables because they can harbor infectious microorganisms.
C. This patient can have more than one visitor at a time.
D. Toys and items from home can be brought in.
4. A 7-year-old child presents to the emergency department, where the parent reports a 3-
week history of pale skin, extreme fatigue, and dizziness. Which laboratory value would
the nurse correlate with the patient’s current condition?
a. Hematocrit: 33%
b. Hemoglobin: 13.2 g/dL
c. Red blood cell count: 2.8/mm3
d. White blood cell count: 12.3/mm3
ANS: C
Chapter: Chapter 26 Caring for the Child With Cancer
Objective: #4. Explore diagnostic and laboratory testing, and medications for common
childhood cancers.
Page: 894
Heading: Anemia
Integrated Processes: Nursing Process: Implementation
Client Need: Physiological
Integrity: Reduction of Risk Potential
Cognitive Level: Analysis [Analyzing]
Concept: Assessment; Critical Thinking
Difficulty: Difficult
Feedback
A. A hematocrit value of 33% is normal.
B. A hemoglobin value of 13.2 g/dL is normal.
C. For a child of this age, a normal RBC count is 4–5.2/mm3. Low RBCs can lead
to pallor, fatigue, headaches, and dizziness as tissues are not being oxygenated.
D. A white blood cell count of 12.3/mm3 is normal.
5. A child has been diagnosed with chronic myelogenous leukemia (CML). Which statement
by the nurse to the parents is most appropriate?
a. “Radiation therapy is the standard treatment.”
b. “The prognosis for this disease is extremely poor.”
c. “There are lots of good medications for nausea.”
d. “We need to test siblings for a bone marrow match.”
ANS: D
Chapter: Chapter 26 Caring for the Child With Cancer
Objective: #4. Explore diagnostic and laboratory testing, and medications for common
childhood cancers.
Page: 877
, Heading: Chronic Myelogenous Leukemia
Integrated Processes: Communication and Documentation
Client Need: Physiological Integrity: Physiological Adaptation
Cognitive Level: Application [Applying]
Concept: Assessment
Difficulty: Moderate
Feedback
A. Radiation therapy is not used.
B. Prognosis for CML is good.
C. Although there are many good medications for nausea, this statement is not the
best choice because it is not specific to this child’s condition.
D. The preferred treatment for CML is a bone marrow or stem cell transplant from
a matching sibling, which can be curative in up to 80% of patients.
6. A nurse is caring for a child who has acute lymphocytic leukemia and has been treated
with doxorubicin (Adriamycin). Which assessment finding would the nurse report
immediately?
a. Loss of appetite
b. Low WBC count
c. Peripheral edema
d. Temperature of 100.6°F (38.1°C), once
ANS: C
Chapter: Chapter 26 Caring for the Child With Cancer
Objective: #4. Explore diagnostic and laboratory testing, and medications for common
child- hood cancers.
Page: 888
Heading: Table 26-2 Chemotherapeutic Agents and Common Cancer Drugs
Integrated Processes: Nursing Process: Implementation
Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies
Cognitive Level: Application [Applying]
Concept: Assessment; Medication
Difficulty: Moderate
Feedback
A. Loss of appetite is a common finding for a child on chemotherapy.
B. Low WBC count is a common finding for a child on chemotherapy.
C. Doxorubicin and other anthracycline drugs are known to cause heart damage.
Peripheral edema may signal heart failure and should be reported right away.
D. A single temperature of 100.6°F does not need to be reported.
7. An 8-year-old child has been diagnosed with a brain tumor. Based on knowledge of
childhood cancers, which intervention does the nurse plan to implement when the child is
