C HAPTER 26: O NCOLOGICAL D ISORDERS
1. A parent tells the nurse that 80% of children with the same type of leukem ia as
his sons have a 5-year survival. He believes that because another child on the
same protocol as his son has just died, his son now has a better chance of
success. What is the best response by the nurse?
a. It is sad for the other family but good news for your child.
b. Each child has an 80% likelihood of 5-year survival.
c. The data suggest that 20% of the children in the clinic will die. There are
still many hurdles for your son.
d. You should avoid the grieving family because you will be benefiting from
their loss.
ANS: B
This is a common misconception for parents. The success data are based on
numerous factors, including the effectiveness of the protocol and the childs
response. These are aggregate data that apply to each child and do not depend
on the success or failure in other children. The failure of one child in a
protocol does not improve the success rate for other children. Although the
son does face more hurdles, these are aggregate data, not specific to the
clinic. It may be difficult for this family to be supportive given their concerns
about their child. Families usually form support groups in pediatric oncology
settings, and support during bereavement is common.
MSC: Client Needs: Psychosocial Integrity
2. 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.
3. 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. Childr en 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.
4. 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.
ANS: B
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.
5. 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.
1. A parent tells the nurse that 80% of children with the same type of leukem ia as
his sons have a 5-year survival. He believes that because another child on the
same protocol as his son has just died, his son now has a better chance of
success. What is the best response by the nurse?
a. It is sad for the other family but good news for your child.
b. Each child has an 80% likelihood of 5-year survival.
c. The data suggest that 20% of the children in the clinic will die. There are
still many hurdles for your son.
d. You should avoid the grieving family because you will be benefiting from
their loss.
ANS: B
This is a common misconception for parents. The success data are based on
numerous factors, including the effectiveness of the protocol and the childs
response. These are aggregate data that apply to each child and do not depend
on the success or failure in other children. The failure of one child in a
protocol does not improve the success rate for other children. Although the
son does face more hurdles, these are aggregate data, not specific to the
clinic. It may be difficult for this family to be supportive given their concerns
about their child. Families usually form support groups in pediatric oncology
settings, and support during bereavement is common.
MSC: Client Needs: Psychosocial Integrity
2. 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.
3. 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. Childr en 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.
4. 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.
ANS: B
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.
5. 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.
