CPHON Pediatric Oncology Nursing Assessment and Care Planning 2 — Questions and Answers
Question 1: A child with Wilms' tumor is post-operative day 2. Which assessment finding is MOST concerning?
- Mild wound discomfort rated 3/10
- Abdomen firm and distended with absent bowel sounds (Correct answer)
- Temperature of 37.4°C
- Urine output of 1.5 mL/kg/hour
Correct answer: Abdomen firm and distended with absent bowel sounds
A firm, distended abdomen with absent bowel sounds post-nephrectomy may indicate paralytic ileus, hemorrhage, or bowel obstruction requiring urgent evaluation.
Question 2: The nurse is preparing a family for a bone marrow biopsy in their child. Which statement is accurate?
- The biopsy requires general anesthesia for all children
- The posterior iliac crest is the most common site in children (Correct answer)
- Results are available within 1 hour
- The procedure is performed via lumbar puncture
Correct answer: The posterior iliac crest is the most common site in children
The posterior iliac crest is the preferred bone marrow biopsy site in children because it provides good marrow access and avoids vital structures.
Question 3: During a nursing handoff, the nurse learns a child with a brain tumor has new onset of unequal pupils. This finding suggests:
- Medication side effect from antiemetics
- Increased intracranial pressure — notify provider immediately (Correct answer)
- Normal variation in lighting
- Dehydration
Correct answer: Increased intracranial pressure — notify provider immediately
Unequal pupils (anisocoria) in a patient with a brain tumor is a neurological emergency indicating possible herniation or increased ICP.
Question 4: A child with osteosarcoma of the femur is preparing for limb-salvage surgery. Which nursing intervention is MOST important pre-operatively?
- Restrict all physical activity for 3 months
- Teach the child about post-operative rehabilitation and expected functional outcomes (Correct answer)
- Avoid discussing the diagnosis with the child
- Apply a pressure bandage to the tumor site
Correct answer: Teach the child about post-operative rehabilitation and expected functional outcomes
Pre-operative teaching about rehabilitation and realistic functional goals reduces anxiety and promotes engagement in post-operative recovery.
Question 5: A toddler with neuroblastoma has periorbital ecchymosis (raccoon eyes). The nurse documents this as a sign of:
- Physical abuse only
- Orbital metastasis from neuroblastoma (Correct answer)
- Iron deficiency anemia
- Normal developmental variant
Correct answer: Orbital metastasis from neuroblastoma
Bilateral periorbital ecchymosis ('raccoon eyes') in children with neuroblastoma indicates orbital metastasis from tumor spread to the skull base.
Question 6: When educating a family about a child's Hickman central venous catheter at home, the nurse should include instructions to:
- Leave the dressing in place indefinitely without changing
- Flush the catheter with heparin or saline per protocol and inspect the site daily (Correct answer)
- Submerge the catheter site in water during bathing freely
- Remove the catheter if there is any redness at the site
Correct answer: Flush the catheter with heparin or saline per protocol and inspect the site daily
Routine flushing per protocol maintains catheter patency, and daily site inspection allows early identification of infection or displacement.
CPHON Pediatric Oncology Nursing Assessment and Care Planning 2
A child with Wilms' tumor is post-operative day 2.
Which assessment finding is MOST concerning?