Oncology/ blood
The nurse is monitoring a child for bleeding after surgery for removal of a brain tumor. The nurse checks the
head dressing for the presence of blood and notes a colorless drainage on the back of the dressing. Which
intervention should the nurse perform immediately?
1. Reinforce the dressing.
2. Notify the health care provider (HCP).
3. Document the findings and continue to monitor.
4. Circle the area of drainage and continue to monitor. - ANSWER: 2. Notify the health care provider (HCP).
Colorless drainage on the dressing in a child after craniotomy indicates the presence of cerebrospinal fluid and
should be reported to the HCP immediately. Options 1, 3, and 4 are not the immediate nursing intervention
because they do not address the need for immediate intervention to prevent complications.
A child undergoes surgical removal of a brain tumor. During the postoperative period, the nurse is monitoring
the child and notes that the child is restless, the pulse rate is elevated, and the blood pressure has decreased
significantly from the baseline value. The nurse suspects that the child is in shock. Which is the most
appropriate nursing action?
1. Notify the health care provider (HCP).
2. Place the child in a supine position.
3. Place the child in Trendelenburg's position.
4. Increase the flow rate of the intravenous fluids. - ANSWER: 1. Notify the health care provider (HCP).
In the event of shock, the HCP is notified immediately before the nurse changes the child's position or
increases intravenous fluids. After craniotomy, a child is never placed in the supine or Trendelenburg's
position because it increases intracranial pressure (ICP) and the risk of bleeding. The head of the bed should
be elevated. Increasing intravenous fluids can cause an increase in ICP.
The mother of a 4-year-old child tells the pediatric nurse that the child's abdomen seems to be swollen. During
further assessment of subjective data, the mother tells the nurse that the child is eating well and that the
activity level of the child is unchanged. The nurse, suspecting the possibility of Wilms' tumor, should avoid
which during the physical assessment?
, 1. Palpating the abdomen for a mass
2. Assessing the urine for the presence of hematuria
3. Monitoring the temperature for the presence of fever
4. Monitoring the blood pressure for the presence of hypertension - ANSWER: 1. Palpating the abdomen for a
mass
Wilms' tumor is the most common intraabdominal and kidney tumor of childhood. If Wilms' tumor is
suspected, the tumor mass should not be palpated by the nurse. Excessive manipulation can cause seeding of
the tumor and spread of the cancerous cells. Hematuria, fever, and hypertension are clinical manifestations
associated with Wilms' tumor.
The pediatric nurse specialist provides a teaching session to the nursing staff regarding osteosarcoma. Which
statement by a member of the nursing staff indicates a need for information?
1. "The femur is the most common site of this sarcoma."
2. "The child does not experience pain at the primary tumor site."
3. "Limping, if a weight-bearing limb is affected, is a clinical manifestation."
4. "The symptoms of the disease in the early stage are almost always attributed to normal growing pains." -
ANSWER: 2. "The child does not experience pain at the primary tumor site."
Osteosarcoma 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. Osteosarcoma is
manifested clinically by progressive, insidious, and intermittent pain at the tumor site. By the time these
children receive medical attention, they may be in considerable pain from the tumor. Options 1, 3, and 4 are
accurate regarding osteosarcoma.
The nurse analyzes the laboratory values of a child with leukemia who is receiving chemotherapy. The nurse
notes that the platelet count is 19,500 cells/mm3. On the basis of this laboratory result, which intervention
should the nurse include in the plan of care?
1. Initiate bleeding precautions.
2. Monitor closely for signs of infection.
3. Monitor the temperature every 4 hours.
The nurse is monitoring a child for bleeding after surgery for removal of a brain tumor. The nurse checks the
head dressing for the presence of blood and notes a colorless drainage on the back of the dressing. Which
intervention should the nurse perform immediately?
1. Reinforce the dressing.
2. Notify the health care provider (HCP).
3. Document the findings and continue to monitor.
4. Circle the area of drainage and continue to monitor. - ANSWER: 2. Notify the health care provider (HCP).
Colorless drainage on the dressing in a child after craniotomy indicates the presence of cerebrospinal fluid and
should be reported to the HCP immediately. Options 1, 3, and 4 are not the immediate nursing intervention
because they do not address the need for immediate intervention to prevent complications.
A child undergoes surgical removal of a brain tumor. During the postoperative period, the nurse is monitoring
the child and notes that the child is restless, the pulse rate is elevated, and the blood pressure has decreased
significantly from the baseline value. The nurse suspects that the child is in shock. Which is the most
appropriate nursing action?
1. Notify the health care provider (HCP).
2. Place the child in a supine position.
3. Place the child in Trendelenburg's position.
4. Increase the flow rate of the intravenous fluids. - ANSWER: 1. Notify the health care provider (HCP).
In the event of shock, the HCP is notified immediately before the nurse changes the child's position or
increases intravenous fluids. After craniotomy, a child is never placed in the supine or Trendelenburg's
position because it increases intracranial pressure (ICP) and the risk of bleeding. The head of the bed should
be elevated. Increasing intravenous fluids can cause an increase in ICP.
The mother of a 4-year-old child tells the pediatric nurse that the child's abdomen seems to be swollen. During
further assessment of subjective data, the mother tells the nurse that the child is eating well and that the
activity level of the child is unchanged. The nurse, suspecting the possibility of Wilms' tumor, should avoid
which during the physical assessment?
, 1. Palpating the abdomen for a mass
2. Assessing the urine for the presence of hematuria
3. Monitoring the temperature for the presence of fever
4. Monitoring the blood pressure for the presence of hypertension - ANSWER: 1. Palpating the abdomen for a
mass
Wilms' tumor is the most common intraabdominal and kidney tumor of childhood. If Wilms' tumor is
suspected, the tumor mass should not be palpated by the nurse. Excessive manipulation can cause seeding of
the tumor and spread of the cancerous cells. Hematuria, fever, and hypertension are clinical manifestations
associated with Wilms' tumor.
The pediatric nurse specialist provides a teaching session to the nursing staff regarding osteosarcoma. Which
statement by a member of the nursing staff indicates a need for information?
1. "The femur is the most common site of this sarcoma."
2. "The child does not experience pain at the primary tumor site."
3. "Limping, if a weight-bearing limb is affected, is a clinical manifestation."
4. "The symptoms of the disease in the early stage are almost always attributed to normal growing pains." -
ANSWER: 2. "The child does not experience pain at the primary tumor site."
Osteosarcoma 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. Osteosarcoma is
manifested clinically by progressive, insidious, and intermittent pain at the tumor site. By the time these
children receive medical attention, they may be in considerable pain from the tumor. Options 1, 3, and 4 are
accurate regarding osteosarcoma.
The nurse analyzes the laboratory values of a child with leukemia who is receiving chemotherapy. The nurse
notes that the platelet count is 19,500 cells/mm3. On the basis of this laboratory result, which intervention
should the nurse include in the plan of care?
1. Initiate bleeding precautions.
2. Monitor closely for signs of infection.
3. Monitor the temperature every 4 hours.
