Nokea
A young child with leukemia has anorexia and severe stomatitis. What approach should the nurse suggest that the parents try?
- A. Relax any eating pressures.
- B. Firmly insist that the child eat normally.
- C. Serve foods that are either hot or cold.
- D. Provide only liquids because chewing is painful.
Correct Answer: A
Rationale: Relaxing eating pressures and offering soft, bland foods with mouthwashes and anesthetics support nutrition in children with stomatitis and anorexia. Insisting on normal eating creates conflict, hot/cold foods may irritate mucosa, and liquids alone are insufficient.
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As part of the diagnostic evaluation of a child with cancer, biopsies are important for staging. What statement explains what staging means?
- A. Extent of the disease at the time of diagnosis
- B. Rate normal cells are being replaced by cancer cells
- C. Biologic characteristics of the tumor or lymph nodes
- D. Abnormal, unrestricted growth of cancer cells producing organ damage
Correct Answer: A
Rationale: Staging describes the extent of cancer at diagnosis, correlating with prognosis. It doesn?t measure cell replacement rates, describe tumor biology (which is classification), or define cancer growth mechanisms, but rather quantifies disease spread for treatment planning.
What immunization should not be given to a child receiving chemotherapy for cancer?
- A. Tetanus vaccine
- B. Inactivated poliovirus vaccine
- C. Diphtheria, pertussis, tetanus (DPT)
- D. Measles, mumps, rubella (MMR)
Correct Answer: D
Rationale: MMR, a live virus vaccine, risks severe disease in immunocompromised children receiving chemotherapy. Tetanus, inactivated poliovirus, and DPT are safe but may have reduced efficacy, often delayed until immunosuppression resolves.
The parents of a child with cancer tell the nurse that a bone marrow transplant (BMT) may be necessary. What information should the nurse recognize as important when discussing this with the family?
- A. BMT should be done at the time of diagnosis.
- B. Parents and siblings of the child have a 25% chance of being a suitable donor.
- C. If BMT fails, chemotherapy or radiotherapy will need to be continued.
- D. Finding a suitable donor involves matching antigens from the human leukocyte antigen (HLA) system.
Correct Answer: D
Rationale: HLA matching is critical for successful BMT, ensuring donor compatibility. BMT timing varies by disease, parents share only about 50% genetic material, and discussing post-failure treatments is premature during initial planning.
The nurse is caring for a child receiving chemotherapy for leukemia. The childs granulocyte count is 600/mm3 and platelet count is 45,000/mm3. What oral care should the nurse recommend for this child?
- A. Rinsing mouth with water
- B. Daily toothbrushing and flossing
- C. Lemon glycerin swabs for cleansing
- D. Wiping teeth with moistened gauze or Toothettes
Correct Answer: B
Rationale: With granulocytes above 500/mm3 and platelets above 40,000/mm3, daily toothbrushing and flossing are safe and effective for oral hygiene. Water rinsing is inadequate, lemon glycerin swabs irritate and dry mucosa, and gauze/Toothettes are for lower counts.
What pain management approach is most effective for a child who is having a bone marrow test?
- A. Relaxation techniques
- B. Administration of an opioid
- C. EMLA cream applied over site
- D. Conscious or unconscious sedation
Correct Answer: D
Rationale: Conscious or unconscious sedation is most effective for managing pain during bone marrow tests, with relaxation, opioids, and EMLA as adjuncts. Sedation ensures comfort and minimizes distress during this invasive procedure.