N316B – Child and Family Health Nursing – Oncology and Hematology
Questions and Answers
The hospice nurse is visiting a client diagnosed with end-stage lung cancer and metastases to
the bone. What should the nurse keep in mind when planning for effective pain management?
AHigh doses of opioid analgesics will be required.
BPain therapy is based on the client's report of pain.
CRelief of pain will be achieved quickly.
DThe client will most likely become addicted. B
Every person's pain experience is unique and should be treated based on the individual's goals
for pain management. Therefore, the amount of medication needed is dependent on the
client's needs and reports of pain relief. The nurse should not assume that high doses of
analgesics will be needed to alleviate the client's pain. Immediate or quick pain relief might be
difficult to achieve, especially in light of the client's type of cancer and bone metastases.
Addiction is a psychological condition and not a concern for this client. However, the client may
develop a physical dependence and tolerance to pain medications that may require an increase
in dosage to manage pain effectively.
A nurse is teaching a parent how to administer oral iron supplements to a 2-year-old child.
Which intervention should be included in the teaching?
AStop the medication if the stools become tarry green
BAdd the medicine to a bottle of formula
,CGive the medicine with orange juice and through a straw
DAdminister the iron with your child's meals C
Absorption of iron is facilitated in an environment rich in vitamin C. Because liquid iron
preparation will stain teeth, a straw should be used. Parents should be informed that dark, tarry
stools are expected outcomes of taking iron supplements. Iron is best absorbed on an empty
stomach (but it may be given after meals if the child experiences an upset stomach).
The nurse is developing a plan of care for a client who has developed blisters and sores in the
mouth after receiving chemotherapy. Which interventions should the nurse include? Select all
that apply.
Examine your mouth frequently.
Use strong mouthwashes to kill bacteria.
Drink 2 or more liters of water per day.
Suck on ice chips during chemotherapy.
Visit a dental hygienist weekly.
Avoid spicy or acidic foods. Examine your mouth frequently.
Use strong mouthwashes to kill bacteria.
,Drink 2 or more liters of water per day.
Suck on ice chips during chemotherapy.
Mucositis is a complex, multiphase process at the cellular level started in response to cytotoxic
chemotherapy. The epithelial cells in the mouth are very sensitive to chemotherapy due to
their high rate of cell turnover. Oral cryotherapy using ice water or ice chips can be used for the
prevention of mucositis. It is believed that vasoconstriction caused by the cold temperature
decreases exposure of the oral mucous membranes to the mucositis-causing agents. Frequent
mouth assessment, and good and frequent oral hygiene are key in managing mucositis. The
client should avoid the use of "strong" mouthwashes that often contain alcohol. Mucositis can
be managed at home and does not require seeing a dental hygienist. Increased hydration is
generally recommended.
The oncology nurse is preparing to administer the initial dose of vincristine to a child diagnosed
with acute lymphocytic leukemia. Which interventions should the nurse include in the plan of
care? Select all that apply.
Apply pressure to the injection site if extravasation occurs.
Monitor liver function tests regularly.
Monitor for numbness or tingling in the fingers and toes.
Select the appropriate catheter for intrathecal administration.
Verify blood return before, during and after intravenous administration. Monitor liver
function tests regularly.
, Monitor for numbness or tingling in the fingers and toes.
Verify blood return before, during and after intravenous administration.
Acute lymphocytic leukemia (ALL) is the most common type of cancer in children and treatment
protocols include vincristine, an anticancer drug. Vincristine is for intravenous use only;
intrathecal (i.e., spinal) administration can be fatal. Vincristine is a vesicant that can cause
significant local damage if extravasation occurs; treatment includes subcutaneous injection of
an antidote and warm compresses (topical cooling may worsen the effect). Peripheral
neuropathy is a major side effect associated with vincristine. The nurse should monitor for
decreased hepatic functioning because vincristine is metabolized in the liver.
A 32-year-old female with human epidermal growth factor receptor 2-positive (HER2-positive)
metastatic breast cancer is scheduled to begin therapy with pertuzumab. What information is
important for the nurse to reinforce and discuss with the client? Select all that apply.
Other therapies for cancer treatment are no longer needed.
Use contraception during and for 6 months following the use of this drug.
Take the medication at the same time every day on an empty stomach.
Report shortness of breath, lightheadedness, dizziness, cough or swelling of the feet.
Report chills, fatigue, or headache during treatment Use contraception during and for 6
months following the use of this drug.
Report shortness of breath, lightheadedness, dizziness, cough or swelling of the feet.
Questions and Answers
The hospice nurse is visiting a client diagnosed with end-stage lung cancer and metastases to
the bone. What should the nurse keep in mind when planning for effective pain management?
AHigh doses of opioid analgesics will be required.
BPain therapy is based on the client's report of pain.
CRelief of pain will be achieved quickly.
DThe client will most likely become addicted. B
Every person's pain experience is unique and should be treated based on the individual's goals
for pain management. Therefore, the amount of medication needed is dependent on the
client's needs and reports of pain relief. The nurse should not assume that high doses of
analgesics will be needed to alleviate the client's pain. Immediate or quick pain relief might be
difficult to achieve, especially in light of the client's type of cancer and bone metastases.
Addiction is a psychological condition and not a concern for this client. However, the client may
develop a physical dependence and tolerance to pain medications that may require an increase
in dosage to manage pain effectively.
A nurse is teaching a parent how to administer oral iron supplements to a 2-year-old child.
Which intervention should be included in the teaching?
AStop the medication if the stools become tarry green
BAdd the medicine to a bottle of formula
,CGive the medicine with orange juice and through a straw
DAdminister the iron with your child's meals C
Absorption of iron is facilitated in an environment rich in vitamin C. Because liquid iron
preparation will stain teeth, a straw should be used. Parents should be informed that dark, tarry
stools are expected outcomes of taking iron supplements. Iron is best absorbed on an empty
stomach (but it may be given after meals if the child experiences an upset stomach).
The nurse is developing a plan of care for a client who has developed blisters and sores in the
mouth after receiving chemotherapy. Which interventions should the nurse include? Select all
that apply.
Examine your mouth frequently.
Use strong mouthwashes to kill bacteria.
Drink 2 or more liters of water per day.
Suck on ice chips during chemotherapy.
Visit a dental hygienist weekly.
Avoid spicy or acidic foods. Examine your mouth frequently.
Use strong mouthwashes to kill bacteria.
,Drink 2 or more liters of water per day.
Suck on ice chips during chemotherapy.
Mucositis is a complex, multiphase process at the cellular level started in response to cytotoxic
chemotherapy. The epithelial cells in the mouth are very sensitive to chemotherapy due to
their high rate of cell turnover. Oral cryotherapy using ice water or ice chips can be used for the
prevention of mucositis. It is believed that vasoconstriction caused by the cold temperature
decreases exposure of the oral mucous membranes to the mucositis-causing agents. Frequent
mouth assessment, and good and frequent oral hygiene are key in managing mucositis. The
client should avoid the use of "strong" mouthwashes that often contain alcohol. Mucositis can
be managed at home and does not require seeing a dental hygienist. Increased hydration is
generally recommended.
The oncology nurse is preparing to administer the initial dose of vincristine to a child diagnosed
with acute lymphocytic leukemia. Which interventions should the nurse include in the plan of
care? Select all that apply.
Apply pressure to the injection site if extravasation occurs.
Monitor liver function tests regularly.
Monitor for numbness or tingling in the fingers and toes.
Select the appropriate catheter for intrathecal administration.
Verify blood return before, during and after intravenous administration. Monitor liver
function tests regularly.
, Monitor for numbness or tingling in the fingers and toes.
Verify blood return before, during and after intravenous administration.
Acute lymphocytic leukemia (ALL) is the most common type of cancer in children and treatment
protocols include vincristine, an anticancer drug. Vincristine is for intravenous use only;
intrathecal (i.e., spinal) administration can be fatal. Vincristine is a vesicant that can cause
significant local damage if extravasation occurs; treatment includes subcutaneous injection of
an antidote and warm compresses (topical cooling may worsen the effect). Peripheral
neuropathy is a major side effect associated with vincristine. The nurse should monitor for
decreased hepatic functioning because vincristine is metabolized in the liver.
A 32-year-old female with human epidermal growth factor receptor 2-positive (HER2-positive)
metastatic breast cancer is scheduled to begin therapy with pertuzumab. What information is
important for the nurse to reinforce and discuss with the client? Select all that apply.
Other therapies for cancer treatment are no longer needed.
Use contraception during and for 6 months following the use of this drug.
Take the medication at the same time every day on an empty stomach.
Report shortness of breath, lightheadedness, dizziness, cough or swelling of the feet.
Report chills, fatigue, or headache during treatment Use contraception during and for 6
months following the use of this drug.
Report shortness of breath, lightheadedness, dizziness, cough or swelling of the feet.
