NUR 2356 FINAL EXAM 2 LATEST VERSIONS 2024-2025 MULTIDIMENSIONAL CARE 1 FINAL/ MDC 1 FINAL, Exams of Nursing

Download NUR 2356 FINAL EXAM 2 LATEST VERSIONS 2024-2025 MULTIDIMENSIONAL CARE 1 FINAL/ MDC 1 FINAL and more Exams Nursing in PDF only on Docsity! NUR 2356 FINAL EXAM 2 LATEST VERSIONS 2024-2025 MULTIDIMENSIONAL CARE 1 FINAL/ MDC 1 FINAL EXAM QUESTIONS AND CORRECT ANSWER S|RASMUSSEN COLLEGE/GET IT 100% ACCURATE !! Red blood cell production is stimulated by: 1. Tachycardia 2. Tachypnea 3. Renin angiotensin 4. Hypoxia - correct answer Hypoxia 4 Main components of blood composition - correct answer RBC, WBC, platelets, plasma What is the composition of plasma - correct answer 90% H2O 10% solutes - glucose, protein, albumin, hormones, etc Where is bone marrow aspiration in infants? - correct answer Tibia Where is bone marrow aspiration in toddlers and preschoolers? - correct answer femur and tibia Where is bone marrow aspiration in children over 5? - correct answer pelvis (iliac crest) Where is bone marrow production in young adults/adults? - correct answer ribs, sternum, vertebra, pelvis, skull, clavicle, scapula what is anemia - correct answer a condition in which levels of red blood cells and hemoglobin are lower than normal 4 types of anemia - correct answer Iron deficiency lead poisoning sickle cell B-thalassemia Define iron deficiency anemia - correct answer reduction in the iron stores of the body causing an inadequate production of hemoglobin What is iron needed for? - correct answer to make hgb signs and symptoms of iron deficiency anemia - correct answer pallor tachycardia tachypnea lethargy fatigue irritability Why are neonates at risk for iron deficiency anemia? - correct answer -lack the maternal iron stores -Full term infants have maternal iron stores until approximately 6 months of age -Havent had the time in utero to store up the needed iron supply (preterm) How can you treat a neonate with iron deficiency anemia? - correct answer Iron fortified formula signs of anemia (lead poisoning) - correct answer pallor, fatigue, weakness, shortness of breath, headache, tachycardia - because lead replaces iron in Hgb causing anemia Growth and developmental lags in lead poisoning - correct answer learning difficulties Neurologic signs and symptoms of lead poisoning - correct answer -Headache, irritability, difficulty concentrating, loss of motor skills, paralysis, tremors High levels: encephalopathy, seizures, and brain damage Gastrointestinal signs and symptoms of lead poisoning - correct answer abdominal pain, failure to gain weight, weight loss, vomiting, constipation Lead poisoning diagnostics - correct answer Blood lead level (BBL) test -5mcg/dL = lead exposure -45 mcg/dL = medical treatment required with chelation therapy ->70= mcg/dL = severe lead toxicity Therapeutic management of lead poisoning - correct answer -Decontamination -Chelation -Supportive therapy -Deterrence and prevention How do you decontaminate a person with lead poisoning? - correct answer Xray of GI tract to see of lead is there. if it is, they flush it out to stop absorption when to use Chelation therapy for lead poisoning - correct answer -45-69 mcg/dL outpatient therapy with oral succorer and parenteral disodium calcium edetate ->70 Hospitalization with dimercaprol and disodium calcium EDTA -Monitor urinary output (possibly on 24 hour urine collection) What do patients who have lead poisoning need in their diet? - correct answer Adequate calcium, iron, and vitamin C Chelation drugs - correct answer 1.Edetate calcium disodium (CaNA2EDTA) 2.Succimer (Chemet) 3.Dimercaprol (BAL in Oil) Information on Chelation drug Edetate calcium disodium (CaNA2EDTA) - correct answer -Given IM or IV for 5 days - Increase lead concentrations in CNS resulting in encephalopathy in its with BLL >70 mcg/dL, used in combination with dimercaprol Information on chelation drug Succimer (Chemet) - correct answer -Given po every 8hrs x 5 days, then every 12 hours x 2 wks -Capsules contain small beads that can be mixed with food. Cannot be given through a syringe Information on chelation drug Dimercaprol (BAL in Oil) - correct answer -Drug of choice in severe lead toxicity cases (BLL >70) -IM every 4 hours with CaNA2EDTA started with dose 2 -Do not give with peanut allergy because it is made with peanut oil -No iron supplements if receiving Dimercaprol because it can form toxic complex if mixed with iron Nursing interventions with lead poisoning - correct answer Monitoring parameters -Blood lead levels -Monitor fluid intake and urine output -Seizure precautions Dietary Considerations -High iron -Limit milk intake to 24 hours -Adequate calcium and vitamin c Prevention - screening -Nutrition education: iron rich foods, calcium rich foods, vitamin c rich foods Define sickle cell disease - correct answer Sickle cell disease is a group of disorders that affects hemoglobin. People with this disorder have atypical hemoglobin molecules called hemoglobin S, which can distort red blood cells into a sickle or crescent shape What is normal adult hemoglobin? - correct answer Hemoglobin A What is the primary hemoglobin produced by the fetus? - correct answer Hemoglobin F When does Hemoglobin F transfer into Hemoglobin A? - correct answer Around 1-2 years old Hemoglobin F does what to sickling of red blood cells? - correct answer inhibits the sickling Define hemoglobinopathy - correct answer A hemoglobin abnormality is a variant form of hemoglobin that is often inherited and may cause a blood disorder (abnormal production or structure of hemoglobin molecules) What is the primary hemoglobin in patients with sickle cell anemia? - correct answer Hemoglobin S What causes increased production of Hemoglobin F? And why? - correct answer Hydroxurea because it causes immunosuppression and it acts like a chemo drug Infection prevention in sickle cell patients - correct answer -Penicillin prophylaxis = oral penicillin until 5 years old -Immunization schedule modification ~ Routine PVC-13 given. two doses of 23-valent pneumococcal at age 2 and 5 ~ Meningococcal vaccine 4 dose series: 2, 4, 6, 12 months ~Hemophilus influenzae type B (Hib) vaccine at age 2 years (additional dose) ~Annual flu vaccine 3 major crises seen in children with sickle cell anemia - correct answer aplastic crisis splenic sequestration vast-occlusive crisis (VOC) Define aplastic crisis - correct answer Transient suppression of RBC production in the bone marrow with hemolysis of all blood cells (temporary shutdown of red blood cells) What can cause aplastic crisis? - correct answer -Infection = viral, especially human parvovirus B19 (Fifths disease) -Depletion of folic acid What are the clinical manifestations of aplastic crisis? - correct answer -Profound anemia, pallor -Neutropenia - fever; Risk for infection -Thrombocytopenia - risk for bleeding anywhere What is the treatment for aplastic anemia? - correct answer Packed RBC transfusion Define splenic sequestration - correct answer Pooled blood in spleen is not available to the general circulation and it is life threatening because it can lead to splenic rupture What are the clinical manifestations of splenic sequestration - correct answer -Profound anemia -Hypovolemia -Shock Therapeutic management of splenic sequestration - correct answer -Blood transfusion -Splenectomy Define vaso-occlusive crisis - correct answer Stasis of blood with clumping of cells in the microcirculation causing ischemia (insufficient supply of blood) and infarction (an area of tissue necrosis) What can cause vaso-occlusive crisis - correct answer -Dehydration -extreme temperatures -infection -localized hypoxemia -stress Therapeutic management of vaso-occlusive crisis - correct answer -pain control -hydration -rest -increase tissue perfusion -treat infection Pharmacological and non pharmacological pain control measures for sickle cell anemia - correct answer -Opiates (PCA pump) -NSAIDS -Around the clock -Acetaminophen -Warm compresses -Guided imagery -Distraction -Relaxation Why is adequate hydration so important in children with sickle cell anemia - correct answer Dehydration can cause sickling and clumping of cells, keeps the kidneys working well, and reduced incidence of stroke What teaching can you do related to hydration? - correct answer -how much fluid they should get and then more -Drink on commercial breaks -drinking games Define acute chest syndrome and what is it most commonly caused by - correct answer A life threatening complication caused by vascular occlusion in the lungs (Sickling of blood in lungs) caused by bacterial pneumonia - esp streptococcus pneumoniae 2. Oral supplementation of vitamin C and avoidance of iron rich foods 3. Splenectomy 4. Bone marrow or stem cell transplants Define hemophilia and what are the 2 types - correct answer A group of hereditary bleeding disorders that result from a deficiency in specific clotting factors 1. Hemophilia A or "Classic hemophilia" = missing Factor VIII (antihemophilic factor-AHF) 2. Hemophilia B or "Christmas disease" = missing Factor IX (plasma thromboplastin component - PTC) How is hemophilia diagnosed? - correct answer -History of bleeding -X-linked inheritance -Lab findings What lab tests would be ordered on a patient who is suspected to have hemophilia? - correct answer Clotting studies - PT, PTT, aPTT, INR Coagulating factor concentrations A patient with hemophilia is placed on what precautions and what are the goals when they are hospitalized and at home? - correct answer Bleeding precautions/ prevention of bleeding Hospitalized -No rectal temps -No continuous BP monitoring -No IM if possible -Stool softeners, if risk for constipation Home -Avoid injury -Medication administration -School education What are the clinical manifestations of hemophilia - correct answer -Prolonged bleeding, bruising, and epistaxis -Internal bleeding -Hemarthrosis - bleeding into the joint cavity ~ early signs = feeling of stiffness, tingling, or ache followed by decrease in the ability to move the joint A nurse is suspecting their patient with hemophilia is bleeding internally based on the assessment findings from GI, GU, and CNS. What assessment findings lead them to this suspect and what nursing interventions might be performed? - correct answer GI: abdominal pain, frank blood in stool or dark black stool, vomiting blood ~ NSG: guaiac stool GU: abdominal or lower back pain, blood in urine ~NSG: perform urine dipstick for hematuria and encourage PO fluids CNS: headache, change in LOC, weakness, gait change ~NSG: neuro assessments Therapeutic management of a bleeding episode in a patient with hemophilia - correct answer - Administer medications ~factor for moderate to severe hemophiliacs (prophylactic treatment to prevent bleeding episodes with sever hemophilia) ~ Desmopressin Acetate (DDAVP) for mild to moderate Hemophilia A patients -Administration of blood products (packed RBC or FFP) -Nursing considerations ~Double check the factor or blood product transfusion with another RN hemarthrosis -For hemarthrosis (bleeding in joint): immobilize and elevate (RICE) Define Immune thrombocytopenic purpura (ITP) - correct answer A bleeding disorder characterized by increased destruction of platelets in spleen platelet destruction due to an antiplatelet antibody that destroys platelets making this an autoimmune disorder A patient presents to the hospital with excessive bruising, miniature petechiae, large areas of asymmetrical ecchymosis, epistaxis, and marked thrombocytopenia but normal WBC, Hgb, and Hct. What condition may this patient have? - correct answer Immune thrombocytopenic purpura (ITP) True or false: Children with Immune thrombocytopenic purpura (ITP) require immediate medical treatment. - correct answer FALSE!!!! many children only require observation and reevaluation of labs. No medical interventions are required 2.check the identification of the recipient along with his/her blood type and group against the donor, regardless of the blood type being used 3.administer the first 50mL of blood or initial 20% of the volume slowly and stay with the child 4. administer with normal saline piggyback setup or have it available 5. administer blood through an appropriate filter and gently shake it frequently 6. use blood within 30 minutes of it arrival from blood bank. if there is a delay in the start of it, return it to the bank. DO NOT store it in the unit fridge. 7. infuse a unit of blood (or specified amount within 4 hours) 8. assess for signs and symptoms of a transfusion reaction A nurse checks on their patient who is receiving a blood transfusion. The patient complains of a sudden severe headache, chills but hot (has a fever), nausea/ vomiting, a tight feeling in their chest, pain at the needle site and in their vein, red or black urine when the went, and flank pain. The nurse is also seeing progressive signs of shock and/or renal failure. What is happening to their patient? - correct answer Transfusion reaction A nurse notices their patient is having a blood transfusion reaction. What are the appropriate steps they must take? - correct answer 1. STOP THE TRANSFUSION 2. Maintain a patent IV line and notify the doctor 3. save donor blood to recroscsmatch with the patients blood 4. monitor for evidence of shock 5. send samples of the patients urine to lab 6. observe for signs of hemorrhage 7. may administer acetaminophen or diphenhydramine 8. Transfusion may be restarted after medication administration depending on the type of transfusion Define hematopoietic stem cell transplantation (HSCT) and what are stem cells able to do? - correct answer -Uses harvested, unique immature cells (stem cells) to grow into new bone marrow producing cells -Stem cells are able to differentiate into any type of hematologic cell Where are hematopoietic stem cells harvested from? - correct answer Bone marrow, peripheral blood, and umbilical blood What are the 2 types of stem cell transplant and their definitions? - correct answer Autologous = patients own stem cells are used Alogenic = stem cells from a donor are used Match the patient to the site of bone marrow harvesting (sites can be used more than once): Infant/young children Children over 5 Adults Tibia Iliac crest (pelvis) Sternum - correct answer Infant/ young children: tibia Children over 5: iliac crest (pelvis) Adults: sternum or iliac crest A nursing student is telling her instructor what she knows about bone marrow transplants. Which options may need more teaching? "It destroys the patients existing bone marrow" "It is a process of 7-10 days of high dose chemo and radiation" "The donated bone marrow is administered via central venous catheter" - correct answer NONE! all options are correct What complications can occur from bone marrow transplant or stem cell transplant? - correct answer GRAFT VS HOST DISEASE (GVHD) - risk with allogenic donor cells graft failure, infection, electrolyte imbalance, and bleeding A patient presents to the hospital with a maculopapular skin rash/ full thickness wounds, abdominal pain and cramps, nausea, vomiting, diarrhea, jaundice (and possible other liver bear little resemblance to host cells uncontrolled replication Adult vs. Pediatric Cancers - correct answer Adults: cancer is often the result of dietary issues or prolonged exposure to toxins from bad habits --> can be prevented through lifestyle changes Children: cancer is usually embryonic or oncogenic (cellular change that allows unregulated genetic activity and tumor growth) --> lifestyle changes have little effect on the incidence of childhood cancer A child presents to the hospital with an unusual mass/swelling, pallor, fatigue, unexplained bleeding/bruising/petechiae, persistent localized pain/limping, prolonged unexplained fever/illness, frequent headaches with vomiting, sudden eye and vision changes, and excessively rapid weight loss. What is the nurse suspecting the child may have? - correct answer cancer What diagnostic tests can the nurse anticipate the doctor ordering if cancer is suspected? - correct answer LAB: CBC, electrolytes, kidney, liver, and bone marrow function (bone marrow analysis and biopsy) Diagnostic procedures: lumbar puncture, bone marrow aspiration, tumor biopsy Diagnostic imaging: x-ray, CT, MRI, PET scan, MIBG scan (neuroblastoma and soft tissue tumor suspection) Why do we stage cancer? - correct answer staging describes the extent of the disease locally, regionally, and systemically and in most tumors guides the therapy A nursing student is learning about cancer staging and sees 3 letters that identify classification. TNM. What do those letters mean? And what do they identify? - correct answer T- Tumor N-Lymph M-Metastasis they identify protocol for treatment What are the 3 goals of cancer treatment and define them - correct answer Curative - rid the child's body of the cancer Supportive - interventions to assist the body's defenses and increase the child's comfort End of life - make the child as comfortable as possible when no curative treatment is possible A group of residents are discussing treatments for a child with cancer. What are all the methods the nurse could anticipate being ordered? - correct answer -Surgery -Chemotherapy -Radiotherapy (radiation) -Biotherapy (Biologic response modifiers) -Hematopoietic stem cell transplantation -End of life care if curative doesn't work Why is surgery frequently a part of cancer therapy for children? - correct answer to obtain a biopsy tumor resection (partial or total) What other surgical procedures are done as part of cancer therapy? - correct answer Central venous catheter or implanted port placement A mother is upset her child needs an implanted port (Port-a-cath, infusaport, mediport, norport) for cancer treatment. What benefits could the nurse tell her about the implanted port to ease her anxiety? - correct answer -Reduced risk of infection -Stable- not easily pulled out since it is placed completely under the skin -Heparinized monthly and after each infusion to maintain patency and can remain in place for years -No limitations on regular physical activity including swimming. Excluding vigorous contact sports -Dressing needed only when Huber needle is in place -only slight change in body appearance A child needs an implanted port for cancer treatments. He loves sports and wants to play football but is devastated when he finds out he can't. What statement by the nurse would be most appropriate? "Sorry you can't play football. You are sick and have to rest." "You are too young for a sport like that. How about you play with your trucks instead" "I am sorry you cant play football, but you are able to do another sport like swimming!" "You heard what the doctor said, no sports." - correct answer "I am sorry you cant play football, but you are able to do another sport like swimming!" What is an important topic of education for a child with an implanted port? - correct answer Signs and symptoms of infection - fever, redness, tachycardia What is AHRQ? - correct answer Agency for Healthcare Research and Quality -No recommendation made regarding frequency for replacing needles to access implantable ports What is the administration of specific drugs that kill both normal and cancerous cells? - correct answer Chemotherapy How long are cancer drugs administered? - correct answer Until cancer cells are clinically undetectable when the patient is in "permanent remission" or "cure" True or false Normal cell DNA cannot replace itself after chemo because it is permanently damaged - correct answer FALSE!! Normal cell DNA CAN repair itself after chemo - cancer can't What are the 3 routes of administration for chemo? - correct answer oral, intrathecal (spinal), IV An adolescent is beginning chemotherapy treatments and is wanting to know all the side effects that they will experience. What are the side effects the nurse will tell the patient? - correct answer -Bone marrow suppression - Nadir is the time of greatest bone marrow suppression -Nausea and vomiting - treated with antiemetics -Anorexia and weight loss - nutritious food and dietary supplements -Oral ulcers (oral mucositis) - antifungal treatment and lidocaine -Constipation - stool softeners, increase fluids, encourage fiberous foods -Pain - acetaminophen, opiates, and antidepressants. Avoid NSAIDS due to bleeding risk -Alopecia - patient/parent education (hair return after 3-6 months and can look different) When administering chemotherapy, when do you start antiemetic therapy? - correct answer give first dose 30-60 minutes before chemo and administer for 1-2 days after to prevent nausea A mother states "If my child is having any pain from their chemo treatments I can administer aspirin or ibuprofen to help ease their pain." What would be the most appropriate answer by the nurse? "That sounds like a great idea! Im pleased you understood the teaching." "Do not administer those medications to them. They belong to a group of drugs called NSAIDS and can cause bleeding risk in your child. They can take acetaminophen instead." "I think it would be wise for you to read over the pamphlets again." "You can give that drug to them but make sure it is in low doses." - correct answer "Do not administer those medications to them. They belong to a group of drugs called NSAIDS and can cause bleeding risk in your child. They can take acetaminophen instead." What diet should a child on chemotherapy be eating? - correct answer Neutropenic diet - no microbes in food no fruits, vegetables, or yogurt except for fruits they can peel What does ANC indicate? - correct answer ANC indicates the body's capacity to handle bacterial infections What is the formula for calculating ANC? and an example - correct answer % Neutrophils + % Bands x WBC count Neutrophil count 40% Band count 5% WBC count 4000 (0.4+0.05)x4000 0.45x4000 = 1800 What ANC values would be concerning for a serious risk for infection? And for severe risk for infection? - correct answer <1000 <500 A doctor tells the nurse that the patient that is receiving chemo has a very critical ANC level and is concerned about infections. The doctor tells the nurse that they want to hold the chemo for a while to give the number a chance to fix itself before restarting therapy again. What is the correct action by the nurse? - correct answer Follow the orders because this is accurate. Chemo can be held in order for the body to fix its ANC number so we don't risk severe infection in the patient What are 3 cumulative side effects of chemo? - correct answer -CNS toxicity -Renal toxicity - tumor lysis can cause uric acid release leading to renal toxicity -Skeletal and endocrine dysfunction A child is receiving chemo treatments and tells the nurse his jaw hurts. What should the nurses next action be and why? - correct answer Stop the chemo and notify the physician This is an early neurotoxic effect What are all the side effects of chemo that the nurse should manage? - correct answer - infection What are quality patient outcomes for child with cancer? - correct answer -child and family educated on disease and treatment -Treatment administered on schedule with appropriate drug doses -side effects of treatment managed -treatment complications prevented -child and family coping skills supported -quality of life during treatment maintained -child and family adjusted to chronic illness -growth and development maintained during treatment What cancer occurs when bone marrow is replaced by malignant blast cells? - correct answer leukemia What leukemia occurs when abnormal lymphoblasts (immature B and T cell lymphocytes) abound in blood forming tissues? - correct answer ALL - acute lymphoblastic leukemia What leukemia affects myeloid cells (any WBC other than lymphocytes) progenitors and precursors in bone marrow, resulting in malignant (invasive and fast growing cells)? - correct answer AML - acute myelogenous leukemia What test is done to diagnose leukemia? - correct answer Bone marrow biopsy What is bone marrow replaced by with leukemia? - correct answer Lymphoblastic cells Which leukemia is the most common form? - correct answer ALL What is the peak incidence and survival rate of ALL? - correct answer 2-5 years peak incidence 80% cure rate What age does AML occur in and what is the survival rate? - correct answer less than 2 years and adolescents 50% survival rate What blood cells does AML affect (SATA): neutrophils basophils t cells eosinophil B cells - correct answer neutrophils basophils eosinophil What blood cells does ALL affect (SATA): neutrophils basophils t cells eosinophil B cells - correct answer T cells B cells A nursing instructor asks a group of nursing students to explain how leukemia occurs. What would their answer be? - correct answer -stem cells in the bone marrow produce immature WBCs that cannot function normally -these cells proliferate rapidly causing the bone marrow to fill with these abnormal WBCs -the abnormal cells replace the normally functioning WBCs in the circulatory system -This makes the patient vulnerable to infections -The malignant WBCs rapidly fill the bone marrow, replacing stem cells that produces erythrocytes (RBCs) and other blood products such as platelets What lab and diagnostic tests should the nurse anticipate being ordered for a child with possible leukemia? and what would the indicated tests show? -CBC -Peripheral blood smear -Bone marrow aspiration what are the goals of induction therapy and how long should it take? - correct answer 4-6 weeks -0-5% of blast cells in bone marrow -All cell lines to recover from induction therapy -Until no evidence of leukemia cells in peripheral blood and no evidence of CNS disease How many years cancer free means the child is cured from leukemia? - correct answer 5 years Which leukemia affects the myeloid progenerator that often impacts granulocyte development (neutrophils, basophils, and eosinophils)? - correct answer Acute myelogenous leukemia (AML) A nurse has 2 patients. One with ALL and one with AML. Which patient is sicker than the other and has a poorer prognosis so they cannot do maintenance treatment? - correct answer AML - because they are sicker, we don't want to do maintenance and see if they relapse because of the higher mortality rate AML is proliferation of what cells? and give info about that cell. - correct answer proliferation of myeloblastic cell myeloblasts are he earliest identifiable cells that give rise to granulocytes. They are normally found in blood forming tissue of bone marrow but may appear in blood in a variety of diseases, most notably AML What are 3 other names for AML? - correct answer Myeloid, myelocytic, myeloblastic What phases of chemo will a patient with AML receive, how long, and why? - correct answer Induction and consolidation ONLY 6-9 months no maintenance because we don't want to see if they relapse because it is a poor prognosis Induction is the bone marrow suppression and prolonged hospitalization is required A nurse notices that her patient with AML is not responding well to treatment. What should she recommend to the doctor? 1. Higher strength chemo 2. placed on hospice care 3. bone marrow transplant 4. continue with treatment and see if it will resolve itself - correct answer Bone marrow transplant Why do we differentiate between the cell type for AML and ALL? - correct answer so we can do the right therapy/treatment and determine the correct plan and prognosis Which cells are involved in AML? - correct answer Myeloid pro generator cells - affects the neutrophils, basophils, and eosinophils Who is more affected by AML? - correct answer Children less than 2 and adolescents What should a nurse watch for if his AML patient is on a more intense treatment regimen? - correct answer Toxicity What is the main treatment for ALL and AML? - correct answer Chemo Which type of leukemia is more responsive to treatment? - correct answer ALL What specific diagnostic test is used for leukemia? - correct answer Bone marrow aspiration (biopsy) Why is a lumbar puncture done for leukemia? - correct answer Determine CNS involvement - to check for blast cells What patients receive intrathecal chemo and why? - correct answer All patients 50% relapse without it A mother brings her child into the ER and complains that he has been projectile vomiting every morning for some time and is concerned about him. What is projectile vomiting the most common sign for? - correct answer Brain tumor Where are the most common brain tumor sites (SATA) Cerebrum Cerebellum Brainstem Midbrain - correct answer Cerebellum What diagnostic tests and rationales that may be ordered on a child with a brain tumor? - correct answer -CT = determine location and metastasis -MRI = extent of tumor and metastatic spread -PET = scan whole body and uptake of radio tracers by cancer cells -Angiogram = X-ray of vessels to see blood supply to tumor -Lumbar puncture with CSF evaluation -Biopsy = Definitive dx What diet should a child be on 24 hours prior to diagnostic tests foe brain tumor? - correct answer low carb What is the primary mode of treatment for a brain tumor? - correct answer Surgery What are the 3 reasons for brain surgery when a patient has a brain tumor? - correct answer - obtain a biopsy -debulk or exercise the tumor -shunt insertion to treat hydrocephalus Besides surgery, what are the other treatment methods for a brain tumor? - correct answer - Radiation - may use to shrink the tumor and then surgery to remove (not for children under 3) - chemotherapy - increase dose to cross the blood brain barrier - Hematopoietic stem cell transplant What should the nurse monitor for post-op of brain tumor - correct answer -Vitals and assessment = monitor for hypothermia from anesthesia/manipulation of brain stem -Pain management -Positioning of child - specific orders, generally flat to prevent shift of brain tissue, off operative site withheld and neck in alignment -Increased ICP -Seizure activity What is the most common extracranial solid tumor of childhood and the most common cancer diagnosed in infancy - correct answer Neuroblastoma Where does a neuroblastoma originate and primary site? - correct answer -originates from embryonic neural crest cells that normally give rise to the adrenal medulla and the sympathetic NS -primary site is the abdomen; other sites include the head and neck region, chest, and pelvis What is a solid tumor (smooth, hard, nontender mass) that occurs anywhere along the sympathetic NS - correct answer Neuroblastoma Where are common sites for metastasis of neuroblastoma? lymph nodes bone marrow skeletal system liver - correct answer All are correct Is a neuroblastoma a form of brain cancer? - correct answer NO What is the difference between a neuroblastoma and a willms tumor? - correct answer The willms tumor does not cross the midline while the neuroblastoma does What are clinical manifestations of a neuroblastoma? - correct answer -Abdominal - firm, nontender, irregular mass in abdomen that crosses the midline -Neuro impairment -Respiratory obstruction from thoracic mass -varying degrees of paralysis from compression on spinal cord Edema of face, ocular problems, headache, difficulty breathing, pain in lower extremity, edema, loss of bowel and bladder function, weight loss, abdominal distention, enlarged liver, irritability, fatigue, fever, sensory loss, inability to walk (can compress spinal cord), altered body functions What are diagnostic tests for a neuroblastoma - correct answer Aimed at locating primary site and areas of metastasis -CT abdomen, pelvis, or chest -Bone scan and MIBG scintiscan to evaluate for presence of skeletal metastasis -Bone marrow biopsy -adrenals -brain -pericardium What are the treatment methods for osteosarcoma surgery chemo radiation - correct answer Surgery chemo Osteosarcoma is radioresistant and radiation is not effective Reasons for treatment method in osteosarcoma - correct answer Surgery - limb salvage or limb amputation chemo - pre surgery = to shrink tumor; especially with limb salvage - post surgery = aggressive to improve survival rate and prevent or treat metastasis What is Ewing sarcoma? and common sites of it? - correct answer -Malignant, small, round cell tumor usually involving the diaphyseal (shaft) portions of long bones (any bone can be affected) -Common sites: femur, pelvis, tibia, fibula, ribs, humerus, scapula, and clavicle Which bone tumor is this patient experiencing based on the clinical manifestations: Pain, swelling, fever, increased WBC, increased erythrocyte sedimentation rate, increased c- reactive protein, possible fracture of affected bone (because it is in the shaft) - correct answer Ewing sarcoma If Ewing sarcoma occurs in the ribs, what could happen - correct answer respiratory compromise What are the 4 treatments for Ewing sarcoma in order of operation - correct answer 1.Chemo - reduce the tumor 2. radiation to follow 3.limb salvage 4. Chemo after initial treatment to prevent metastasis Is Ewing sarcoma radiosensitive or radioresistant - correct answer Radiosensitive - radiation can be effective What is the most common nephroblastoma - correct answer Wilms tumor Why should you never palpate the abdomen of a patient with Wilms tumor - correct answer because it can spread cancer cells and cause seeding - be careful with bathing and handling of the child What are 2 treatment methods of Wilms tumor - correct answer Nephrectomy and chemo - may do radiation for larger tumors or if they have an unfavorable histology Peak incidence of Wilms tumor - correct answer 3-4 years old Post op care for surgery on Wilms tumor - correct answer monitor BP, s/s of infection (esp with chemo), abdominal surgery care (may need NG tube) Rhabdomyosarcoma is a: -malignant bone neoplasm -nonmalignant soft tissue tumor -malignant solid tumor -malignant solid tumor of striated muscle - correct answer Malignant solid tumor of striated muscle Define rhabdomyosarcoma - correct answer soft-tissue tumor of striated muscle in head and neck (eye orbits), and less commonly in abdomen, genitourinary tract, and extremities What is the most common soft tissue tumor - correct answer Rhabdomyosarcoma What age does rhabdomyosarcoma mostly effect - correct answer 5 years What tests help determine location of rhabdomyosarcoma - correct answer PET, CT, MRI Signs and symptoms of Rhabdomyosarcoma - correct answer -Eye orbit = proptosis - bulging eye - Genitourinary = urinary obstruction, hematuria, vaginal discharge, and protruding vaginal mass -Abdomen - may be asymptomatic, GI and urinary tract obstruction, pain, weakness, paresthesia What are diagnostic tests for rhabdomyosarcoma - correct answer -radiographic studies