Nokea
The nurse is administering an intravenous chemotherapeutic agent to a child with leukemia. The child suddenly begins to wheeze and have severe urticaria. What nursing action is most appropriate to initiate?
- A. Recheck the rate of drug infusion.
- B. Stop the drug infusion immediately.
- C. Observe the child closely for next 10 minutes.
- D. Explain to the child that this is an expected side effect.
Correct Answer: B
Rationale: Wheezing and urticaria indicate an allergic reaction, requiring immediate cessation of the chemotherapeutic agent, withdrawal of remaining drug, and initiation of a saline infusion. Checking the rate, observing further, or dismissing as expected delays critical intervention.
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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.
Total-body irradiation is indicated for what reason?
- A. Palliative care
- B. Lymphoma therapy
- C. Definitive therapy for leukemia
- D. Preparation for bone marrow transplant
Correct Answer: D
Rationale: Total-body irradiation destroys the immune system to prepare for bone marrow transplant, increasing complication risks until engraftment. It?s not used for palliative care, lymphoma, or leukemia as a primary treatment, which rely on other modalities.
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.
A school-age child with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time. What is the most appropriate nursing action to prevent or minimize these reactions with subsequent treatments?
- A. Administer the chemotherapy between meals.
- B. Give an antiemetic before chemotherapy begins.
- C. Have the child bring favorite foods for snacks.
- D. Keep the child NPO (nothing by mouth) until nausea and vomiting subside.
Correct Answer: B
Rationale: Administering an antiemetic like ondansetron before chemotherapy prevents anticipatory nausea and vomiting. Giving chemotherapy between meals doesn?t prevent nausea, favorite foods may cause aversions, and NPO status risks dehydration and discomfort.
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.