PEDs: Chapter 24 Practice Questions

A 4-year-old child is diagnosed with acute lymphoblastic leukemia (ALL). The nurse notes pallor, bruising, and hepatosplenomegaly. Which lab finding would most likely correlate with these symptoms?

A. ↑ RBC, ↑ platelets, ↑ WBC

B. ↓ RBC, ↓ platelets, ↑ immature WBCs (blasts)

C. ↓ RBC, ↑ platelets, ↓ WBC

D. Normal CBC values

B. ↓ RBC, ↓ platelets, ↑ immature WBCs (blasts)

ALL is marrow replacement by lymphoblasts → decreased production of normal blood cells. This yields anemia (↓ RBC/Hgb), thrombocytopenia (↓ platelets → bruising), and the presence of immature leukemic blasts (often ↑ total WBC or abnormal differential).

Why the others are wrong:

A (↑ RBC, ↑ platelets, ↑ WBC): Opposite of expected marrow failure.

C (↓ RBC, ↑ platelets, ↓ WBC): Platelets are usually ↓ in leukemia from marrow crowding, not ↑.

D (Normal CBC values): Unlikely with the clinical signs of pallor/bruising/hepatosplenomegaly.

Which statement best differentiates childhood cancer from adult cancer?

A. Childhood cancers are usually epithelial in origin.

B. Environmental factors strongly influence childhood cancers.

C. Childhood cancers often metastasize before diagnosis.

D. Childhood cancers are usually preventable through lifestyle changes.

C. Childhood cancers often metastasize before diagnosis.

Pediatric cancers (embryonal/tissue-origin) tend to be aggressive and often diagnosed after metastasis; this is a classic child-vs-adult distinction.

Why the others are wrong:

A: Childhood cancers are usually not epithelial (that's adult carcinomas).

B: Environmental/lifestyle factors have strong influence in adults, not typically in childhood cancers.

D: Childhood cancers are not generally preventable by lifestyle changes; adults are where prevention has major impact.

A 10-year-old with Hodgkin lymphoma presents with drenching night sweats and weight loss. How should the nurse classify this type?

A. Stage II, Type A

B. Stage I, Type B

C. Type B

D. Type A

C. Type B

Hodgkin disease is classified A (no systemic symptoms) or B (fever, drenching night sweats, weight loss >10%). Drenching night sweats and weight loss place the child in B category.

Why the others are wrong:

A & B (stage + type combos): The question asks classification by symptoms (A vs B). Without staging info, stating a stage is inappropriate.

D (Type A): Type A is asymptomatic — does not fit the presence of systemic symptoms.

The nurse is assessing a child with suspected non-Hodgkin lymphoma. Which finding is most concerning for mediastinal involvement?

A. Swollen cervical lymph nodes

B. Abdominal mass

C. Facial edema and venous engorgement

D. Bone pain

C. Facial edema and venous engorgement

A mediastinal mass can compress the superior vena cava (SVC), causing facial/neck swelling, venous engorgement, and possibly respiratory compromise — classic signs of mediastinal involvement.

Why the others are wrong:

A (swollen cervical nodes): Common but not specific to mediastinal involvement.

B (abdominal mass): Suggests abdominal nodal disease, not mediastinum.

D (bone pain): May indicate metastasis but not mediastinal compression.

A child with Wilms tumor is admitted. Which action is contraindicated?

A. Palpating the abdomen carefully

B. Aggressive palpation of the abdominal mass

C. Assessing for hypertension

D. Monitoring for respiratory distress

B. Aggressive palpation of the abdominal mass

Wilms tumor is a fragile renal mass that can rupture or seed tumor cells if palpated aggressively. Standard teaching: do not palpate aggressively; gentle observation only.

Why the others are wrong:

A (palpating carefully): Careful inspection/palpalation by experienced clinician may be done, but aggressive palpation is contraindicated.

C (assessing for hypertension): Appropriate—hypertension is common in Wilms.

D (monitoring for respiratory distress): Appropriate if metastasis suspected.

A nurse is preparing a child for hematopoietic stem cell transplantation (HSCT). Which intervention is highest priority?

A. Provide age-appropriate play activities

B. Initiate protective isolation

C. Teach relaxation techniques

D. Encourage high-calorie diet

B. Initiate protective isolation

HSCT involves high-dose chemo/radiation that ablates the immune system; protective isolation (positive-pressure room, strict infection control) is a top-priority safety measure to prevent fatal infections.

Why the others are wrong:

A (play activities): Important for psychosocial care but not the highest priority clinically.

C (relaxation techniques): Helpful adjunct but not the primary safety action.

D (high-calorie diet): Nutrition is important but infection prevention is higher priority pre/post-transplant.

A child is receiving chemotherapy for ALL. The nurse should implement neutropenic precautions when:

A. ANC = 2,000

B. ANC = 1,200

C. ANC = 500

D. ANC = 1,000

C. ANC = 500

Neutropenic precautions are typically instituted when ANC < 500 cells/µL, placing the patient at highest risk for severe bacterial infection.

Why the others are wrong:

A (2,000) and B (1,200) and D (1,000): These ANC values are low-moderate neutropenia but do not usually trigger the full neutropenic precaution set (threshold is ANC <500).

The nurse is caring for a child post-brain tumor resection. Which position is most appropriate?

A. Flat on the back with head elevated 45°

B. Side-lying (unaffected side) with head aligned

C. Trendelenburg position

D. Supine with pillows under knees

B. Side-lying (unaffected side) with head aligned

After posterior fossa or cranial surgery, side-lying on the unaffected side with the head flat or as prescribed maintains airway protection, minimizes ICP changes, and prevents pressure on operative site per neurosurgical orders.

Why the others are wrong:

A (head elevated 45°): Excessive elevation can alter cerebral perfusion/ICP depending on surgeon's orders — standard is usually slight elevation (up to 30°) or flat depending on procedure. 45° is generally too high immediately post-op.

C (Trendelenburg): Increases ICP — contraindicated.

D (Supine with pillows under knees): Supine may increase ICP; pillows under knees can increase venous return and ICP.

A 3-year-old is diagnosed with neuroblastoma. Which assessment finding is most characteristic?

A. Abdominal mass, firm and non-tender

B. Strabismus and nystagmus

C. Headache and vomiting

D. Cervical lymphadenopathy

A. Abdominal mass, firm and non-tender

Neuroblastoma commonly presents as a firm, non-tender abdominal mass (often adrenal origin). Many cases have metastasis at diagnosis.

Why the others are wrong:

B (strabismus/nystagmus): More typical of intracranial tumors, not classic for abdominal neuroblastoma.

C (headache/vomiting): Signs of CNS tumor/ICP, not typical first sign of neuroblastoma.

D (cervical lymphadenopathy): Possible with metastasis but not the characteristic primary finding.

Which chemotherapy effect is considered long-term?

A. Alopecia

B. Nausea

C. Infertility

D. Oral mucositis

C. Infertility

Infertility is a recognized long-term adverse effect of many chemotherapeutic agents and radiation, especially if gonads are exposed or with alkylating agents.

Why the others are wrong:

A (Alopecia), B (Nausea), D (Oral mucositis): These are acute/short-term chemo side effects, not long-term sequelae.

A child with ALL is receiving intrathecal chemotherapy for CNS prophylaxis. What is the primary purpose of this treatment?

A. Reduce systemic side effects

B. Prevent CNS relapse

C. Increase RBC production

D. Reduce nausea and vomiting

B. Prevent CNS relapse

Intrathecal chemo (e.g., methotrexate) is given as CNS prophylaxis in ALL to prevent leukemic infiltration of the CNS where systemic chemo penetrates poorly.

Why the others are wrong:

A (Reduce systemic side effects): Intrathecal route treats/prevents CNS disease — not aimed at reducing systemic side effects.

C (Increase RBC production): Not the purpose.

D (Reduce nausea/vomiting): Not relevant.

A 7-year-old with osteosarcoma reports new shortness of breath. The nurse should suspect:

A. Tumor recurrence in the femur

B. Pulmonary metastasis

C. Cardiac complication from chemo

D. Anxiety

B. Pulmonary metastasis

Osteosarcoma commonly metastasizes to the lungs; new shortness of breath in a patient with osteosarcoma is highly suspicious for pulmonary metastasis or embolic/complication—pulmonary mets are most likely.

Why the others are wrong:

A (Tumor recurrence in femur): May cause local pain but less likely to present acutely with dyspnea.

C (Cardiac complication from chemo): Possible (e.g., anthracycline cardiomyopathy) but less likely to appear acutely as new dyspnea in adolescent without other signs; pulmonary mets are more common.

D (Anxiety): Should be considered but must rule out serious causes (metastasis) first.

A nurse is caring for a child with retinoblastoma. Which intervention is most important to discuss with the parents?

A. Avoid palpating the abdomen

B. Report any eye or vision changes

C. Provide a high-calorie diet

D. Administer antiemetics before chemo

B. Report any eye or vision changes

Retinoblastoma affects the retina and vision. Early detection of changes like leukocoria, strabismus, or visual changes is critical for preserving life/vision; parents must report these immediately.

Why the others are wrong:

A (Avoid palpating the abdomen): Not directly relevant to retinoblastoma (abdomen palpation is more for Wilms/neuroblastoma).

C (Provide high-calorie diet): Not a primary retinoblastoma teaching point.

D (Administer antiemetics before chemo): A general chemo teaching point but not the MOST important parent education specific to retinoblastoma.

The nurse is teaching a family about radiation therapy for a child with lymphoma. Which statement demonstrates understanding?

A. "I can remove the skin markings after each treatment."

B. "I should scrub the skin gently before each session."

C. "I will protect the skin and monitor for breakdown daily."

D. "Radiation is safe at any age without long-term effects."

C. "I will protect the skin and monitor for breakdown daily."

Radiation damages skin; protecting marked areas, gentle care, and daily skin assessment are correct. Patients must not remove radiation markings and should avoid scrubbing or irritating the skin.

Why the others are wrong:

A ("I can remove the skin markings"): Wrong — markings must be kept intact.

B ("I should scrub the skin gently"): Wrong — scrubbing can irritate radiation site.

D (Radiation safe at any age): Wrong — radiation has significant long-term effects, especially in young children.

Which statement is true regarding non-Hodgkin lymphoma (NHL) in children?

A. NHL usually presents with slow-growing superficial lymph nodes.

B. NHL rarely spreads to the CNS.

C. NHL is aggressive, fast-growing, and responds well to treatment.

D. NHL has a poorer prognosis than Hodgkin lymphoma regardless of stage.

C. NHL is aggressive, fast-growing, and responds well to treatment.

Pediatric NHL tends to be high-grade/aggressive but chemo-sensitive, often requiring prompt multiagent therapy and CNS prophylaxis.

Why the others are wrong:

A (slow-growing superficial nodes): Incorrect — NHL is typically fast and often deep.

B (rarely spreads to CNS): False — pediatric NHL has a significant risk of CNS spread.

D (poorer prognosis always vs HL): Not universally true; prognosis varies by subtype and stage; many localized NHLs have excellent outcomes.

Which nursing intervention is appropriate to prevent hemorrhage in a child receiving chemotherapy?

A. Administer iron supplements

B. Limit blood draws and avoid rectal temps

C. Encourage ambulation and activity

D. Give high-calorie meals

B. Limit blood draws and avoid rectal temps

To prevent hemorrhage in thrombocytopenic patients, minimize invasive procedures (limit blood draws), avoid rectal temps/meds/exams (risk mucosal bleeding), and avoid IM injections where possible.

Why the others are wrong:

A (Administer iron supplements): Good for iron-deficiency anemia but does not prevent bleeding risk from thrombocytopenia.

C (Encourage ambulation and activity): Activity may increase trauma risk when platelet counts are low.

D (Give high-calorie meals): Nutrition supports growth but does not prevent hemorrhage.

A child is admitted with Ewing sarcoma of the pelvis. Which is the most critical nursing priority?

A. Monitor for bone metastasis and pain

B. Promote oral hygiene

C. Provide psychosocial support

D. Teach energy conservation

A. Monitor for bone metastasis and pain

Ewing sarcoma commonly metastasizes to lungs and other bones; pain and metastasis surveillance (and fracture risk) are high priorities. Managing pain and monitoring for metastasis directly affects morbidity/mortality.

Why the others are wrong:

B (Promote oral hygiene): Important during chemo but not the most critical priority for Ewing sarcoma specifically.

C (Provide psychosocial support): Crucial but secondary to monitoring and managing the physical disease process.

D (Teach energy conservation): Helpful but not the top immediate priority.

A child with ALL is prescribed erythropoietin (EPO). When should the nurse anticipate EPO production naturally occurs?

A. Kidneys before birth

B. Liver after birth

C. Kidneys after birth, liver before birth

D. Liver and kidneys after birth

C. Kidneys after birth, liver before birth

Erythropoietin (EPO) production shifts from liver in utero to kidneys after birth — classic physiology fact.

Why the others are wrong:

A (Kidneys before birth): Wrong — kidneys take over after birth.

B (Liver after birth): Wrong — liver is main fetal source, not postnatal.

D (Liver and kidneys after birth): Wrong — the fetal liver produces EPO before birth; after birth kidneys primarily produce EPO.