What are the most common signs and symptoms of leukemia related to bone marrow involvement Quizlet

The primary consequences of leukemia in children are: I. Infection, from neutropenia
II. Anemia, from decreased RBCs
III. Vascular inflammation, from entanglement and enmeshing of RBCs
IV. Bleeding, from decreased platelets

a. I, II, and IV

b. II, III, and IV

c. I, II, and III

Questions from wong textbook Topics: Cancer, chronic/terminal illness, endocrine/metabolic, GI, GU, Hematologic conditions, Immunologic conditions, procedures & treatments, mental health problems

Terms in this set (79)

A. Petechiae, infection, and fatigue are signs of infiltration of the bone marrow. Petechiae occur from lowered platelet count, infection occurs from the depressed number of effective leukocytes, and fatigue occurs from the anemia.

Headache, papilledema, and irritability are not signs of bone marrow involvement.

Muscle wasting, weight loss, and fatigue are not signs of bone marrow involvement.

Decreased intracranial pressure, psychosis, and confusion are not signs of bone marrow involvement.

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(Parents of children diagnosed with cancer require major emotional support, and should be allowed to express their feelings. Prevention and blaming oneself is not supportive, nor is telling the parents that there are many other children with cancer.)

The mother of a child diagnosed with a potentially life-threatening form of cancer says to the nurse, "I don't understand how this could happen to us. We have been so careful to make sure our child is healthy." Which response by the nurse is most appropriate?

A. "This must be a difficult time for you and your family. Would you like to talk about how you are feeling?"
B. "Why do you say that? Do you think that you could have prevented this?"
C. "You shouldn't feel that you could have prevented the cancer. It is not your fault."
D. "Many children are diagnosed with cancer. It is not always life-threatening."


(While all options can be done to encourage nutrition, allowing the preschooler choices meets two issues: nutrition and developmental tasks.)

A preschool-age child undergoing chemotherapy experiences nausea and vomiting. Which of the following would be the best intervention to include in the child's plan of care?

a. Administer tube feedings.
b. Offer small, frequent meals.
c. Offer fluids only between meals.
d. Allow the child to choose what to eat for meals.


(Hodgkin's disease is a neoplasm of lymphatic tissue. The presence of gaint multinucleated cells ( Reed- Sternbergs cells) is the hallmark of this disease. The presence of blast cells in the bone marrow indicates leukemia. The Epstein-Barr virus is associated with infectious mononucleosis . Elevated levels of vanillylmandelic acid in the urine may be found in children with neroblastoma.)

A 12 year old boy seen in the clinic, and a diagnosis of Hodgkin's disease is suspected . Which diagnostic test results confirm the diagnosis of Hodgkin's disease?

A . Elevated vanillylmandelic acid urinary level.
B. The presence of blast cells in the bone marrow
C. The presence of Epsetin-Barr virus in the blood.
D. The presence of Reed-Sternberg cells in the lymph nodes


(While all of the nursing diagnoses listed here are important, dehydration and fluid and electrolyte loss secondary to vomiting is the priority for this client.)

Which nursing diagnosis is highest-priority for a child undergoing chemotherapy and experiencing nausea and vomiting?

A. Fluid and Electrolyte Imbalance
B. Alterations in Nutrition
C. Alterations in Skin Integrity
D. Body Image Disturbances


(The lab values presented all are normal except for the platelet count. Decreases in platelet counts place the child at greatest risk for hemorrhage.)

A child with cancer has the following lab result: WBC 10,000, RBC 5, and plts of 20,000. When planning this child's care, which risk should the nurse consider most significant?

A. Hemorrage
B. Anemia
C. Infection
D. Pain


(To ensure that the client receives optimal doses of chemotherapy, dosing is usually based on the total Body surface area(BSA) which requires accurate height and weight before each med administration.
Simply asking the client about height/weight may lead to inaccuracies in determining BSA. Calculating BMI and measuring abdominal girth does not provide the data needed.)

Chemotherapy dosage is frequently based on total body surFace area (BSA), so it is important for the nurse to do which of the following before administering chemotherapy?

A. Measure abdominal girth
B. Claculate BMI
C. Ask the client about his/her height and weight
D. Weigh and measure the client on the day of medication administration


(Surface blood vessels of polyps and cancers are fragile and often bleed with the passage of stools, so a fecal occult blood test and CT scan can help establish tumor size and metastasis. A colonoscopy can help to locate a tumor as well as polyps, but is only recommended every 10 years.)

Which diagnostic test should be performed annually after age 50 to screen for colon cancer?

a. Abdominal computed tomography (CT)
b. Abdominal X-ray
c. Colonoscopy
d. Fecal occult blood test


(One of the most valuable clues to pain is a behavior change: A child who's pain-free likes to play. A child in pain is less likely to consume food or fluids. An increased heart rate may indicate increased pain; decreased urine output may signify dehydration.)

David, age 15 months, is recovering from surgery to remove Wilms' tumor. Which findings best indicates that the child is free from pain?

a. Decreased appetite
b. Increased heart rate
c. Decreased urine output
d. Increased interest in play


(Leukemia is a malignant increase in the number of leukocytes, usually at an immature stage, in the bone marrow. It affects the bone marrow, causing from decreased erythrocytes, infection from neutropenia, and bleeding from decreased platelet production. If the platelet count is les than 20,000 than bleeding precautions need to be taken.)

A nurse analyzes the lab values of a child with leukemia who is receiving chemotherapy. The nurse notices that the platelet count is 19,500 cell/mm3. Based on this lab value which intervention would the nurse document in her plan of care.

A. Monitor closely for signs of infection.
B. Temp every four hours.
C. Isolation precautions
D. Use a small toothbrush for mouth care"


(Chemotherapeutic agents decrease the immunity of
the child. Proper use of the mask will decrease the chance of acquiring
an infection. Cancer is not spread; a mask cannot contain moisture; and
unsightly mouth sores are not a medical reason to wear a mask.)

The parent of a child undergoing chemotherapy asks the nurse why the child must wear a mask in public places. Which of the following responses by the nurse would be most appropriate?

A. "Chemotherapy causes dry mouth, and the mask will help contain moisture."
B. "Chemotherapy decreases immune system function, increasing the risk of acquiring an infection."
C. "Chemotherapy makes the oral mucous membranes deteriorate and makes them susceptible to infection."
D, "Chemotherapy kills cancer cells, and your child might spread those cells to others."


(Do not put pressure on the abdomen. Palpation of Wilms' tumor can cause rupture and spread of cancerous cells. Frequent visitation might allow the child to be exposed to more infections, and activity and sports are discouraged because of the risk of rupture of the encapsulated tumor.)

A child is diagnosed with Wilms' tumor. In planning teaching interventions, what key point should the nurse emphasize to the parents?

A. Do not put pressure on the abdomen.
B. Frequent visits from friends and family will improve morale.
C. Appropriate protective equipment should be worn for contact sports.
D. Encourage the child to remain active."


(The most common sign of Wilms' tumor is a painless, palpable abdominal mass, sometimes accompanied by an increase in abdominal girth. Gross hematuria is uncommon, although microscopic hematuria may be present. Dysuria is not associated with Wilms' tumor. Nausea and vomiting are rare in children with Wilms' tumor.)

A child is diagnosed with Wilms' tumor. During assessment, the nurse in charge expects to detect:

a. Gross hematuria
b. Dysuria
c. Nausea and vomiting
d. An abdominal mass


(While all of the answer choices are correct, recommending the use of sunscreen to decrease the incidence of skin cancer (a) is the best response.)

The mother of a 5-year-old child asks the nurse questions regarding the importance of vigilant use of sunscreen. Which information is most important for the nurse to convey to the mother?

a.) Appropriate use of sunscreen decreases the risk of skin cancer.
b.) Repeated exposure to the sun causes premature aging of the skin.
c.) A child's skin is delicate, and burns easily.
d.) In addition to causing skin cancer, repeated sun exposure predisposes the child to other forms of cancer.


(Fever and petechiae associated with acute lymphocytic leukemia indicate a suppression of normal white blood cells and thrombocytes by the bone marrow and put the client at risk for other infections and bleeding. The nurse should initiate infection control and safety precautions to reduce these risks. Fatigue is a common symptom of leukemia due to red blood cell suppression. Although the client should be told about the need for rest and meal planning, such teaching is not the priority intervention. Swollen glands and lethargy may be uncomfortable but they do not require immediate intervention. An enlarged liver and spleen do require safety precautions that prevent injury to the abdomen; however, these precautions are not the priority.)

A 15-year-old has been admitted to the hospital with the diagnosis of acute lymphocytic leukemia. Which of the following signs and symptoms require the most immediate nursing intervention?

A. Fatigue and Anorexia
B. Fever and Petechiae
C. Swollen lymph nodes in the neck and lethargy.
D. Enlarged liver and spleen


(Fresh vegetables harbor microorganisms, which can cause infections in immune-compromised children, fruit or vegetables should be either peeled or cooked. The physician should be notified of a temp above 100 degrees F. A diet low in protein is not indicated. Humidifiers harbor fungi in the water containers.)

A child with leukemia is being discharged after beginning chemotherapy. Which of the following instructions will the nurse include when teaching the parents of this child?

A. provide a diet low in protein and high in carboydrates.
B. avoid fresh vegetables that are not cooked or peeled.
C. notify the doctor if the child's temp exceeds 101 degrees F.
D. increase the use of humidifiers throughout the house.


(1. No - this is not a common cancer in children
2. YES! this is the most common form of cancer found in children is acute lymphocytic leukemia.
3. No - this is not a common cancer in children
4. No - this is not a common cancer in children)

The pediatric nurse understands that the most common cancer found in children is:

A. Non-hodgkin's lymphoma
B. Acute lymphocytic leukemia
C. Chronic lymphocytic leukemia
D. Ewing's sarcoma"


(The abdomen of the child with Wilm's tumor should not be palpated because of the danger of disseminating tumor cells. Children with Wilm's tumor should always be handled gently and carefully.

Other answers. The child's head and chest measuring will not affect Wilm's tumor. Repositioning a child in the upright position may cause more pain to the child, but priority this is not worse than disseminating tumor cells.)

When assessing a child with Wilm's tumor, the nurse should keep in mind that it is most important to avoid which of the following?

A. Measuring the child's chest circumference
B. Palpating the child's abdomen
C. Placing the child in an upright position
D. Measuring the child's occipitofrontal circumference


(Colorectal cancer risk factors include age older than 50 years, a family history of the disease, colorectal polyps, and chronic inflammatory bowel disease.)

A nurse is teaching a client about the risk factors associated with colorectal cancer. The nurse determines that further teaching related to the colo-rectal cancer is necessary if the client identifies which of the following as an associated risk factor?

A. Age younger than 50 years
B. History of coloractal polyps
C. Family history of colorectal cancer
D. Chronic inflammatory bowel disease"


(a-— poses little or no threat
B(CORRECT:)- protects patient from exogenous bacteria,
risk for developing infection from others due to depressed WBC count,
alters ability to fight infection
c-— should be placed in a room alone
d-ensure that patient is provided with
opportunities to express feelings about illness)

What are the needs of the patient with acute lymphocytic leukemia and thrombocytopenia?

A. To a private room so she will not infect other patients and healthcare workers.
B. To a private room so she will not be infected by other patients and health care workers.
C. To a semiprivate room so she will have stimulation during her hospitalization.
D. To a semiprivate room so she will have the opportunity to express her feelings about her illness.


(Because of cerebral edema and the danger of increased intracranial pressure postoperatively, fluids are carefully monitored.
A. Colorless drainage may be leakage of cerebrospinal fluid from the incision site. This needs to be reported as soon as possible.
B. Analgesics can be used for postoperative pain.
C. Child should not be positioned in Trendelenburg position postoperatively.")

The postoperative care of a preschool child who has had a brain tumor removed should include which of the following?

a. colorless drainage is to be expected
b. analgesics are contraindicated because of altered consciousness
c. positioning is on the operative side in the Trendelenberg position
d. carefully monitor fluids due to cerebral edema


(Malaise is the most common side effect of radiotherapy. For children, the fatigue may be especially distressing because it means they cannot keep up with their peers.)

A child with lymphoma is receiving extensive radiotherapy. Which of the following is the most common side effect of this treatment?

A. Malaise
B. Seizures
C. Neuropathy
D. Lymphadenopathy

B, D

(Painless cervical nodes are a hallmark sign of HD. In addition to this, night sweats also are characteristic. Fever, poor appetite, and painful cervical nodes are more characteristic of infection.")

A school-age child is being seen in the oncology clinic for possible Hodgkin's disease. During the course of the nursing assessment, which findings would be expected? Select all that apply.

a) fever.
b) painless cervical nodes.
c) painful cervical nodes.
d) poor appetite.
e) complaints of night sweats"


(Clinical manifestations specifically associated with Hodgkin's disease include painless, firm, and movable adenopathy in the cervical and supraclavicular areas. Hepatosplenomegaly also is noted. Although fever, malaise, anorexia, and weight loss are associated with Hodgkin's disease, these manifestations are seen in many disorders.)

A nurse is performing an assessment on a 10-year old child suspected having Hodgkin's disease. The nurse understands that which of the following assessment findings is characteristic of this disease?

a) fever and malaise
b) anorexia and weight loss
c) painful, enlarged inguinal lymph nodes
d) painless, firm, and movable adenopathy in the cervical area.


(A. Profound weight loss and anorexia occur with pancreatic cancer. Correct.
B. jaundiced patients are concerned about how they look, but physiological needs take priority
C. jaundice causes dry skin and pruritis, scratching can lead to skin breakdown
D. urine is dark due to obstructive process, kidney function is not affected)

The nurse is admitting a patient who is jaundiced due to pancreatic cancer. The nurse should give the highest priority to which of the following needs?

A. Nutrition
B. Self-image
C. Skin integrity
D. Urinary elimination


(Rationale: Wilm's tumor is the most common intra-abdominal and kidney tumor of childhood. If Wilm's tumor is suspected, the tumor mass should not be palpated by the nurse. Excessive manipulation can cause the seeding of the tumor and spread of cancerous cells. Fever, hematuria, and hypertension are all clinical manifestations of Wilm's tumor.)

The mother of a 4 year old child brings the child to the clinic and tells the pediatric nurse specialist that the child's abdomen seems to be swollen. During further assessment of the subjective data, the mother tells the nurse that the child has been eating well and that the activity level of the child is unchanged. The nurse, suspecting the possibility of a Wilm's tumor, would avoid which of the following during the physical assessment?

A. Palpating the abdomen for a mass.
B. Assessing the urine for hematuria
C. Monitoring the temperature for presence of fever
D. Monitoring the blood pressure for presence of hypertension


(Rationale: immunocompromised children are unable to fight varicella adequately. Chickenpox can be deadly to the them. If the child who has not had chickenpox is exposed to someone with varicella, the child should receive varicella zoster immune globulin within 96hrs of exposure. Options 1,3,4, are incorrect because they do nothing to minimize the chances of developing the disease.)

A 9-year old child with leukemia is in remission and has returned to school. The school nurse calls the mother of the child and tells the mother that a classmate has just been diagnosed with chickenpox. The mother immediately calls the clinic nurse because the leukemic child has never had chickenpox. The appropriate response by the clinic nurse to the mother is:

A. There is no need to be concerned.
B. Bring the child into the clinic for a vaccine.
C. Keep the child out of school for 2 week period.
D. Monitor the child for an elevated temperature, and call the clinic if this happens.


(Grieving is an independent problem, and the nurse can assess and treat this problem with or without collaboration)

The nurse is completing a care plan for a client diagnosed with leukemia. Which independent problem should be addressed?

A. Infection.
B. Anemia.
C. Nutrition.
D. Grieving.


(Because neomycin is limited absorption form the GI tract, it exerts it antibiotic effect on the intestinal mucosa. In preparation of GI surgery, the level of microbial organisms will be reduced.)

A client is admitted to the hospital for a colon resection and in preparation for surgery the physician orders neomycin. The nurse understands the main reason why this antibiotic is especially useful before colon surgery is because it:

A. Will not affect the kidneys
B. Acts systemically without delay
C. Has limited absorption from the GI tract.
D. Is effective against many different organisms


(The massive cell destruction resulting from chemotherapy may place the client at risk for developing renal calculi; adding allopurinol decreases this risk by preventing the breakdown of xanthine to uric acid. Allopurinol doesn't act in the manner described in the other options.)

A child is undergoing remission induction therapy to treat leukemia. Allopurinol is included in the regimen. The main reason for administering allopurinol as part of the client's chemotherapy regimen is to:

a. Prevent metabolic breakdown of xanthine to uric acid
b. Prevent uric acid from precipitating in the ureters
c. Enhance the production of uric acid to ensure adequate excretion of urine
d. Ensure that the chemotherapy doesn't adversely affect the bone marrow"


(Leukemia is a neoplastic, or cancerous, disorder of blood-forming tissues that is characterized by a proliferation of immature white blood cells.)

After teaching the parents of a child newly diagnosed with leukemia
about the disease, which of the following descriptions given by the
mother best indicates that she understands the nature of leukemia?

A) "The disease is an infection resulting in increased white blood cell production."
B) "The disease is a type of cancer characterized by an increase in immature white blood cells."
C) "The disease is an inflammation associated with enlargement of the lymph nodes."
D) "The disease is an allergic disorder involving increased circulating antibodies in the blood."


(Hemophila refers to a group of bleeding disorders resulting from a deficiency of specific coagulation proteins. the primary meds used are to replace missing clotting factor. Factor VIII will be prescribed intravenously to replace the missing clotting factor and minimize the bleeding.)

A 10 year old child with hemophilia A has slipped on the ice and bumped his knee. The nurse should prepare to administer an:

A. injection of factor X
B. intravenous infusion of iron
C. intravenous infusion of factor VIII
D. intramuscular injection of iron using the Z track method


(The body compensates for metabolic acidosis via the respiratory system, which tries to eliminate the buffered acids by increasing alveolar ventilation through deep, rapid respirations, altered white blood cell or platelet counts are not specific signs of metabolic imbalance.)

When caring for an 11-month-old infant with dehydration and metabolic acidosis, the nurse expects to see which of the following?

a. A reduced white blood cell count
b. A decreased platelet count
c. Shallow respirations
d. Tachypnea


(The client must be ready to accept changes in body image and function; this acceptance will facilitate mastery of the techniques of colosotomy care and optimal use of community resources.)

The nurse understands a primary step toward achievement of a long range goal associated with the rehabilitation of a client with a new colostomy is:

A. Mastery of techniques of colostomy care
B. Readiness to accept an altered body function
C. Awareness of available community resources
D.Knowledge of the neccessary dietary modifications.


(Chemotherapeutic agents can be extremely damaging to cells. Nurses experienced with the administration of vesicant drugs should be responsible for giving these drugs and be prepared to treat extravasations if necessary.
a. Anaphylaxis is a possibility with some chemotherapeutic and immunologic agents.
b. Infiltration and extravasations are always a risk, especially with peripheral veins.
d. Gloves are worn to protect the nurse when handling the drugs, and the hands should be thoroughly washed afterward.)

Nursing considerations related to the administration of chemotherapeutic drugs include which of the following?

a) Anaphylaxis cannot occur, since the drugs are considered toxic to normal cells.
b) Infiltration will not occur unless superficial veins are used for the intravenous infusion.
c) Many chemotherapeutic agents are vesicants that can cause severe cellular damage if drug infiltrates.
d) Good hand washing is essential when handling chemotherapeutic drugs, but gloves are not necessary.


(Childhood cancers occur most commonly in rapidly growing tissue, especially in the bone marrow. Mortality depends on the time of diagnosis, the type of cancer, and the age at which the child was diagnosed. Children who are diagnosed between the ages of 2 and 9 consistently demonstrate a better prognosis. Treatment strategies are tailored to produce the most favarable prognosis.)

A nurse is discussing childhood cancer with the parents of a child in an oncology unit. Which statement by the nurse would be the most accurate?

A. "The most common site for children's cancer is the bone marrow."
B. "All childhood cancers have a high mortality rate."
C. "Children with leukemia have a higher survival rate if they are older than 11 when diagnosed."
D. "The prognosis for children with cancer isn't affected by treatment strategies."


(Enlarged lymph nodes with progression to extralymphatic sites. This is a characteristic specifically to lymphoma, where as fatigue and weakness can occur with other diseases. Weight loss is more likely than weight gain.)

What assessment finding would the nurse expect to find specifically for a client admitted with Hodgkin's disease?

A. Fatigue
B. weakness.
C. Weight gain
D. Enlarged lymph nodes.


(Knowledge of the usual pattern of spread of this lymphoma, with its orderly progression through lymph node groups and its typical forms of extranodal involvement, facilitates timely diagnosis, staging, and treatment planning.)

What is a characteristic manifestation of Hodgkin's Disease?

A. petechiae
B. erythematous rash
C. enlarged lymph nodes
D. pallor"


(Because the child has only one remaining kidney, it is important to prevent urinary tract infections. Answers A, B, and C are not necessary, so they are incorrect.)

A 4-year-old has a right nephrectomy to remove a Wilms tumor. The nurse knows that it is essential to:

A. Request a low-salt diet
B. Restrict fluids
C. Educate the family regarding renal transplants
D. Prevent urinary tract infections


(Rationale: The goals of cancer treatment are cure, control, and palliation. When cure is the goal, treatment is offered that is expected to have the greatest chance of disease eradication. Curative cancer therapy depends on the particular cancer being treated and may involve local therapies (i.e., surgery or irradiation) alone or in combination, with or without periods of adjunctive systemic therapy (i.e., chemotherapy).)

The goals of cancer treatment are based on the principle that

A. surgery is the single most effective treatment for cancer.
B. initial treatment is always directed toward cure of the cancer.
C. a combination of treatment modalities is effective for controlling many cancers.
D. although cancer cure is rare, quality of life can be increased with treatment modalities.


(Rationale: Neutropenia is a decreased number of neutrophil cells in the blood which are responsible for the body's defense against infection. Rest and avoid exertion would be related to erythrocytes and oxygen carrying properties. Monitoring the blood pressure, and observing for bruising would be related to platelets and sign and symptoms of bleeding.)

After a client is admitted to the pediatric unit with a diagnosis of acute lymphocytic leukemia, the laboratory test indicates that the client is neutropenic. The nurse should perform which of the following?

a. Advise the client to rest and avoid exertion
b. Prevent client exposure to infections
c. Monitor the blood pressure frequently
d. Observe for increased bruising


(Preschoolers have the cognitive ability to understand simple terms. Use of a favorite doll is contraindicated because it is ""part"" of that child and he/she might perceive the doll is experiencing pain.)

A preschool-aged child is to undergo several painful procedures. Which of the following techniques is most-appropriate for the nurse to use in preparing the child?

A. Allow the child to practice injections on a favorite doll.
B. Explain the procedure in simple terms.
C. Allow a family member to explain the procedure to the child.
D. Allow the child to watch an educational video.


(Swelling or lumps or masses anywhere on the body are early warning signs whereas difficulty swallowing or cough or hoarseness are signs of cancer in adults. there may be a marked sign in changes to bowel or bladder function, not a slight change.)

Which condition assessed by the nurse would be an early warning sign of childhood cancer?

A. difficulty swallowing
B. nagging cough or hoarseness
C. slight changes in bowel and bladder function
D. swelling, lumps, masses on body


(Rationale: An undifferentiated cell has an appearance more like a stem cell or fetal cell and less like the normal cells of the organ or tissue. The DNA in cancer cells is always different from normal cells, whether the cancer cells are well differentiated or not. All tumor cells are mutations form the normal cells of the tissue.)

A patient who has been told by the health care provider that the cells in a bowel tumor are poorly differentiated asks the nurse what is meant by "poorly differentiated." Which response should the nurse make?

a. "The cells in your tumor do not look very different from normal bowel cells."
b. "The tumor cells have DNA that is different from your normal bowel cells."
c. "Your tumor cells look more like immature fetal cells than normal bowel cells."
d. "The cells in your tumor have mutated from the normal bowel cells."


(In leukemia, the WBCs that are present are immature and incapable of fighting infection. increases or decreases in the number of WBCs can be related to the disease process and treatment, and not related to infection. the only value that indicates the child is infection-free is the temperature. the use of proper handwashing technique is a measure or intervention used to meet a goal. but is not a goal itself. STRATEGY: the core issue of the question is knowledge of an indicator of infection in a client who is immunosuppressed from leukemia. recall that temperature and WBC counts are frequently used as indicators of infection. recall that in leukemia the WBCs are abnormal so choose the option related to temperature.)

A child being treated for Acute Lymphocytic Leukemia (ALL) has a white blood cell (WBC) count of 7,000/mm3. the nursing care plan lists risk for infection as a priority nursing diagnosis, and measures are being taken to reduce the child's exposure to infection. the nurse determines that the plan has been successful when which outcome has been met?

A. child's WBC count goes up.
B. child's WBC count goes down.
C. child's temperature remains within normal range.
D. parents demonstrate good hand washing technique."


(Osteogenic sarcoma is the most common bone cancer in children. Cancer usually is found in the metaphysis of long bones, especially in the lower extremities, with most tumors occurring in the femur (omit #1). Osteogenic sarcoma is manifested clinically by progressive, insidious, and intermittent pain at the tumor site (correct answer: #2). By the time these children receive medical attention, they may be in considerable pain from the tumor. All options: 1, 3, 4 are accurate regarding osteogenic sarcoma.)

A pediatric nurse specialist provides a teaching session to the nursing staff regarding osteogenic sarcoma. Which statement by a member of the nursing staff indicates a need for clarification of the information presented?

A. "The femur is the most common site of this sarcoma."
B. "The child does not experience pain at the primary tumor site."
C. "Limping, if a weight-bearing limb is affected, is a clinical manifestation."
D. "The symptoms of the disease in the early stage are almost always attributed to normal growing pains."


(The staging of Wilm's tumor is confirmed at surgery as follows: Stage I, the tumor is limited to the kidney and completely resected; stage II, the tumor extends beyond the kidney but is completely resected; stage III, residual nonhematogenous tumor is confined to the abdomen; stage IV, hematogenous metastasis has occurred with spread beyond the abdomen; and stage V, bilateral renal involvement is present at diagnosis.)

A child is admitted to the hospital with a diagnosis of Wilm's tumor, Stage II. Which of the following statements most accurately describes this stage?

A. The tumor is less than 3 cm. in size and requires no chemotherapy.
B. The tumor did not extend beyond the kidney and was completely resected.
C. The tumor extended beyond the kidney but was completely resected.
D. The tumor has spread into the abdominal cavity and cannot be resected.


(Signs of infiltration of the bone marrow are petechiae from lowered platelet count, fever related to infection from the depressed number of effective leukocytes, and fatigue from the anemia.
The other options are not signs of bone marrow involvement.)

The most common signs and symptoms of leukemia related to bone marrow involvement are which of the following?

a. Petechiae, fever, fatigue.
b. Headache, papilledema, irritability.
c. Muscle wasting, weight loss, fatigue.
d. Decreased intracranial pressure, psychosis, confusion.


(Rationale: Neuroblastoma is a solid tumor found only in children. It arises from neural crest cells that develop into the sympathetic nervous system and the adrenal medulla. Typically, the tumor compresses adjacent normal tissue and organs. Neuroblastoma cells may excrete catecholamines and their metabolites. Urine samples will indicate elevated VMA levels. The presence of blast cells in the bone marrow occurs in leukemia. Projectile vomiting occurring most often in the morning and a positive Babinski's sign are clinical manifestations of a brain tumor.)

A diagnostic workup is being performed on a 1-year-old child with suspected neuroblastoma. The nurse reviews the results of the diagnostic tests and understands that which of the following findings is most specifically related to this type of tumor?

A. Elevated vanillylmandelic acid (VMA) urinary levels
B. Presence of blast cells in the bone marrow
C. Projectile vomiting, usually in the morning
D. Postive Babinski's sign"


(Up to 90% of clients respond well to
standard treatment with chemotherapy
and radiation therapy, and those who
relapse usually respond to a change of
chemotherapy medications. Survival
depends on the individual client and
the stage of disease at diagnosis.)

The female client recently diagnosed with Hodgkin's lymphoma asks the nurse about
her prognosis. Which is the nurse's best response?

A. Survival for Hodgkin's disease is relatively good with standard therapy.
B. Survival depends on becoming involved in an investigational therapy program.
C. Survival is poor, with more than 50% of clients dying within six (6) months.
D. Survival is fine for primary Hodgkin's, but secondary cancers occur within a year."


(Because the incidence of testicular cancer is increased in adulthood among children who have undescended testes. It is extremely important to teach the adolescent how to perform the testicular self-examination

An adolescent with a history of surgical repair for undescended testes comes to the clinic for a sport physical. Anticipatory guidance for the parents and adolescent would focus on which of the following as most important?

a) the adolescent sterility
b) the adolescent future plans
c) technique for monthly testicular self-examinations
d) need for a lot of psychosocial support

Common leukemia signs and symptoms include:.
Fever or chills..
Persistent fatigue, weakness..
Frequent or severe infections..
Losing weight without trying..
Swollen lymph nodes, enlarged liver or spleen..
Easy bleeding or bruising..
Recurrent nosebleeds..
Tiny red spots in your skin (petechiae).

Which of the following complications are three main consequences of leukemia?

Answer: B. The three main consequences of leukemia are anemia, caused by decreased erythrocyte production; infection secondary to neutropenia; and bleeding tendencies, from decreased platelet production.

What is the most appropriate way to stop an occasional episode of epistaxis?

Pinch your nose. Use your thumb and index finger to pinch both nostrils shut, even if only one side is bleeding. Breathe through your mouth. Continue to pinch for five to 10 minutes. This maneuver puts pressure on the bleeding point on the nasal septum and often stops the flow of blood.

What is the most appropriate action for stopping an occasional episode of epistaxis or nose bleeding?

Use your thumb and index finger to pinch your nostrils shut. Breathe through your mouth. Continue to pinch for 10 to 15 minutes. Pinching sends pressure to the bleeding point on the nasal septum and often stops the flow of blood.