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Onco- Peds test 4 Questions with Solutions
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Exam of 16 pages for the course cancer at cancer (Onco- Peds test 4)
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Onco- Peds test 41. The nurse is preparing clients for diagnostic testing for cancer. Which test is used to
differentiate a neuroblastoma from other tumors? - answer: Urine catecholamine
metabolites, Hom vanillic acid (HVA), and vanillylmandelic acid (VMA)
Rationale: Neuroblastomas produce catecholamines. Urine catecholamine metabolites,
Hom vanillic acid (HVA), and vanillylmandelic acid (VMA) differentiate neuroblastomas
from other tumors. This exam is done by collecting a 24-hour urine specimen. Urinalysis
provides general information about renal function. Serum chemistries help to evaluate
the body's response to the cancer process. CBC with differential determines abnormal
loss or destruction of cells that may indicate cancer or bone marrow suppression.
The health care provider prescribed an alkylating agent for a child's chemotherapy.
Which best describes an action produced by these types of agents? - answer Answer:
They are cell cycle-nonspecific, destroying both resting and dividing cells.
Rationale: Alkylating agents are cell cycle-nonspecific, destroying both resting and
dividing cells. During alkylation, the hydrogen atoms of some molecules within the cell
are replaced by an alkyl group. This group interferes with DNA replication and RNA
transcription. Interferons are the classification of drugs that are synthesized by bacterial
and fungal agents. Antimetabolites are active in the S phase and act similarly to normal
cellular metabolites. They alter the cell's function to destroy the cell's ability to replicate.
1. The nurse caring for a cancer patient recognizes the signs and symptoms of
syndrome of inappropriate antidiuretic hormone (SIADH) in a patient. Which of the
following are recommended interventions for this emergency condition? Select all that
apply. - answerAnswer:
· Restrict fluids to below maintenance levels.
· Monitor intake and output.
· Monitor specific gravity of each voiding.
· Monitor serum sodium levels.
Rationale: The appropriate interventions for SIADH are to restrict fluids to below
maintenance levels; administer diuretics; and monitor intake and output, specific gravity
of each voiding, serum sodium levels, and seizure activity.
Which symptom would lead the nurse to suspect that a child is developing a common
side effect of vincristine? - answerAnswer: The child says the fingertips feel numb.
Rationale: Vincristine has a number of side effects. Myelosuppression occurs,, which
can cause decreased blood counts, hemorrhage, and anemia. A common side effect of
vincristine is numbness and tingling in the hands and feet. Allopurinol is administered
,when the child is receiving vincristine, because the dying cancer cells cause increased
uric acid. A side effect of the allopurinol is blistering, peeling, and red skin rash. With
both of the drugs the child should be properly hydrated to prevent side effects.
Toothache and hearing loss are symptoms of side effects of other chemotherapeutic
agents, but not vincristine.
1. Which diagnosis would be most appropriate for an infant with a large retinoblastoma
after surgery? - answerAnswer: Disturbed sensory perception related to enucleation
Rationale: Retinoblastoma is a congenital highly malignant tumor. When there is early
detection the goal is to treat the tumor and preserve as much vision as possible. If there
is advanced disease, enucleation is necessary. It may be difficult for an infant or young
child to learn to see the world with only one eye and adapt to this sensation. Pain may
be present but it is not related to retinal removal. The entire eye structure is removed. If
the eye needs to be removed the child has not experienced normal vision for some time
previous to surgery so there would not be fear relating to the loss of normal vision.
Anticipatory grieving would occur more from the parents than the infant.
1. The nurse is caring for a 6-year-old boy with non-Hodgkin lymphoma who is being
treated with monoclonal antibodies. What recommendation would the nurse include in
the child's plan of care? - answerAnswer: Monitoring for allergic reactions or
anaphylaxis.
Rationale: The nurse would monitor for infusion-related reactions and anaphylaxis if
monoclonal antibodies were administered and would have epinephrine, antihistamines,
and steroids available at the bedside for treatment if a reaction occurred. Assessing the
level of hydration due to vomiting would be necessary if tumor necrosis factor was
administered. The flu-like symptoms produced by interferons also require hydration
maintenance. Monitoring for complaints of bone pain is appropriate when administering
colony-stimulating factors such as filgrastim or sargramostim. Assessing for signs of
capillary leak syndrome within 2 to 12 hours of the start of treatment is necessary when
interleukins are used.
The nurse is caring for a 9-year-old boy who is having chemotherapy. The nurse is
developing a teaching plan for the child and family about nutrition. What instruction
would the nurse be least likely to include? - answerAnswer: Concentrating on
consuming primarily high-calorie shakes and puddings.
Rationale: Providing high-calorie shakes and puddings with diet restrictions can help
with weight gain, if that is a problem. However, concentrating on high-calorie shakes
and puddings is not a good strategy. It is best to provide a balanced diet emphasizing
grains, fruits, and vegetables. If pain is being treated with opioid analgesics, featuring
high-fiber foods is important to help relieve constipation. Avoiding milk products is a
good idea if diarrhea is a problem because lactose can make diarrhea worse.
, The nurse is preparing a presentation for a parent group about childhood cancers,
focusing on brain tumors in children. What would the nurse describe as the most
common type of brain tumor? - answerAnswer: medulloblastoma
Rationale: Of all the types of brain tumors listed, a medulloblastoma is the most
common type. It is invasive, is highly malignant, and grows rapidly.
A child is receiving methotrexate as part of his chemotherapy protocol. The nurse would
anticipate administering which agent to counteract the toxic effects of methotrexate? -
answerAnswer: Leucovorin
Rationale: Leucovorin is given as an antidote to methotrexate to reduce its toxic effects.
Mesna is given when cyclophosphamide and ifosfamide are used to prevent
hemorrhagic cystitis. Cyclosporine is an immunosuppressant used to treat graft-versus-
host disease after hematopoietic stem cell transplant. Nystatin is used to treat mucositis
or systemic fungal infection.
A nurse is caring for a terminally ill 7-year-old who is hospitalized and is wishing to go
home? What type of referral can this nurse make so that the child can receive care at
home? - answerAnswer: Hospice care
Rationale: Many children in terminal stages of disease are also cared for at home with
hospice care.
A child is receiving chemotherapy. The chemotherapy is scheduled to begin at 10 a.m.
To prevent nausea and vomiting, the child is prescribed ondansetron. At what time
would it be best to administer the medication? - answerAnswer: 9:30 a.m.
Rationale: To prevent nausea and vomiting from chemotherapy, ondansetron should be
given 30 minutes before beginning chemotherapy. For this child, the correct time would
be 9:30 a.m.
The parents of a child diagnosed with cerebral astrocytoma ask the nurse about their
child's prognosis. Which response by the nurse would be most appropriate? -
answerAnswer: "The prognosis is favorable with complete surgical resection and the
child usually experiences minimal neurologic deficits post-operatively."
Rationale: Cerebral astrocytomas account for approximately 25% of all types of
astrocytomas. The prognosis is favorable with complete surgical resection, and patients
have minimal neurologic deficits post-operatively.
The health care provider prescribes an alkylating agent as part of a child's
chemotherapy regimen. When explaining this classification of drug to the child and
parents, which information would the nurse integrate into the explanation? -
answerAnswer: They are cell cycle-nonspecific destroying both resting and dividing
cells
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