The following sample questions are representative of actual test content, difficulty level, and question format. The answer key follows the set of questions.
Directions: Each question or incomplete statement below is followed by four suggested answers or completions. Select the one that is best in each case.
A teenage sibling of a child newly diagnosed with cancer has begun acting out. The teenager tells the nurse that her parents are ignoring her and placing many constraints on her activities because of the sibling's care. The relationship with the parents is strained and the teen is unsure what to do. The initially recommends a:
- family counseling session for stress management.
- family meeting to further assess interactions.
- contract negotiation between the teen and parents.
- teenage sibling support group.
A child with dysmorphic thumbs has been diagnosed with myelodysplastic syndrome. The nurse anticipates further testing for:
- Evan’s syndrome.
- Fanconi’s anemia.
- Blackfan Diamond anemia.
- Shwachman-Diamond syndrome.
An adolescent with sickle cell disease is started on hydroxyurea. The nurse reviews the side effects of this drug including the patient’s increased risk for:
- cardiac arrhythmias.
- interstitial pneumonitis.
A patient newly diagnosed with acute promyelocytic leukemia has developed disseminated intravascular coagulation. The nurse gives priority to the administration of:
- fresh frozen plasma.
Which of the following most likely contributes to short stature in children who have been treated for cancer?
- Oral steroids.
- Intrathecal methotrexate.
- High-dose cyclophosphamide.
- Total body radiation.
Rationale: Stress in families dealing with chronic illness is inevitable. Based on family systems theory a change in one family member will affect the entire unit. The nurse must assess the family structure and interactions before determining what interventions are appropriate.
Reference: Hockenberry, M.J., & Wilson, D. (2009). Wong's essentials of pediatric nursing. (8th ed.). St. Louis, MO: Mosby, pp. 30-32.
Rationale: Children with Fanconi’s anemia may not be diagnosed until they present with myelodysplastic syndrome or acute myelogenous leukemia. It is often associated with a variety of physical anomalies, including abnormalities of the hands and upper extremities. Blackfan Diamond anemia is a pure red cell aplasia not associated with physical anomalies. Shwachman-Diamond syndrome is a bone marrow failure syndrome associated with other skeletal abnormalities. Evan’s syndrome is an autoimmune hemolytic anemia and not associated with malignant transformations.
Reference: Kline, N.E. (Ed.). (2014). Essentials of pediatric hematology/oncology nursing: A core curriculum (4th ed.). Glenview, IL: Association of Pediatric Hematology/Oncology Nurses. Page 479.
Rationale: Myelosuppression is a common side effect of hydroxyurea. Resulting neutropenia puts the patient at increased risk for infection.
Reference:Kline, N.E. (Ed.). (2014). Essentials of pediatric hematology/oncology nursing: A core curriculum (4th ed.). Glenview, IL: Association of Pediatric Hematology/Oncology Nurses. Page 123, 467.
Rationale: Fresh frozen plasma replaces depleted clotting factors. Although used in the past, there is limited evidence to support the use of heparin. While sepsis can be a cause of disseminated intravascular coagulation, clindamycin is not a choice for broad spectrum coverage. Allopurinol is used to treat tumor lysis syndrome.
Reference: Baggott, C.R., Fochtman, D., Foley, G.V., &Kelly, K.P. (Eds.). (2011). Nursing care of children and adolescents with cancer and blood disorders (4th ed.). Glenview, IL: Association of Pediatric Hematology/Oncology Nurses, pp. 671-672.
Rationale: Total body radiation (TBI) may cause short stature due to its affect on the hypothalamic-pituitary axis resulting in a decrease in growth hormone secretion.
Reference: Pizzo, P.A., & Poplack, D.G. (Eds.). (2011). Principles and practice of pediatric oncology (6th ed.). Philadelphia, PA: Lippincott Williams & Wilkins, p. 1372(t).