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Pediatric Nursing

Childhood Cancer Practice Questions

18 free Childhood Cancer practice questions for the NCLEX Exam. Tap an option to answer — you get instant feedback, the correct answer, and a detailed explanation for every question.

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Question 1 of 18 Easy

What is the most common type of childhood leukemia?

  1. A Acute myeloid leukemia (AML)
  2. B Chronic lymphocytic leukemia (CLL)
  3. C Acute lymphoblastic leukemia (ALL)
  4. D Juvenile myelomonocytic leukemia (JMML)

Correct answer: Acute lymphoblastic leukemia (ALL)

Childhood acute lymphoblastic leukemia (ALL) is the most common type of cancer in children and is the most common form of childhood leukemia.

Question 2 of 18 Easy

In a child diagnosed with Wilms’ tumor, which age group is most likely at presentation?

  1. A 10-12 years
  2. B 7-9 years
  3. C 3-5 years
  4. D 0-1 year

Correct answer: 3-5 years

Wilms’ tumor (nephroblastoma) usually presents in children between about 2 and 5 years of age.

Question 3 of 18 Easy

A red flag symptom for leukemia in a child is:

  1. A A painless abdominal mass
  2. B Recurrent infections, pallor, bruising and bone pain
  3. C Isolated cough lasting 48 hours
  4. D Occasional headache in the evening

Correct answer: Recurrent infections, pallor, bruising and bone pain

Leukemia causes bone marrow replacement by malignant blasts leading to anemia, thrombocytopenia, and neutropenia.

Question 4 of 18 Medium

A key nursing caution when palpating a child’s abdomen suspected for Wilms’ tumor is:

  1. A Always press the mass to assess mobility
  2. B Never palpate vigorously because risk of tumor rupture and dissemination
  3. C Palpation is not needed if child is asymptomatic
  4. D Surgery must be delayed until palpation confirms size

Correct answer: Never palpate vigorously because risk of tumor rupture and dissemination

Because Wilms’ tumor may be encapsulated, palpating too vigorously can cause rupture and spread of cancer cells, thus gentle handling is required.

Question 5 of 18 Medium

Which syndrome is associated with a higher risk of Wilms’ tumor?

  1. A Marfan syndrome, a connective-tissue disorder
  2. B Down syndrome (trisomy 21)
  3. C WAGR syndrome (Wilms, aniridia, GU anomalies, retardation)
  4. D Turner syndrome, a sex-chromosome disorder

Correct answer: WAGR syndrome (Wilms, aniridia, GU anomalies, retardation)

WAGR syndrome includes Wilms’ tumor as one of its components, indicating a genetic association with Wilms’ tumor development.

Question 6 of 18 Medium

In leukemia, which laboratory finding is most consistent with the disease process?

  1. A Elevated mature neutrophils with a normal platelet count
  2. B Markedly low numbers of blast cells within the bone marrow
  3. C Marrow packed with immature lymphoblasts or myeloblasts
  4. D Increased red-cell mass with a low white-cell count

Correct answer: Marrow packed with immature lymphoblasts or myeloblasts

Leukemia involves proliferation of immature blasts (lymphoid or myeloid) in bone marrow which crowd out normal hematopoiesis, leading to anemia, thrombocytopenia, and neutropenia.

Question 7 of 18 Medium

A child with Wilms’ tumour presents with a palpable abdominal mass. Which additional sign is frequently seen?

  1. A Hypotension
  2. B Hypertension
  3. C Jaundice
  4. D Bradycardia

Correct answer: Hypertension

Hypertension may occur in Wilms’ tumour due to renal involvement and increased renin secretion from affected kidney tissue.

Question 8 of 18 Medium

Which statement regarding survival outcomes is most accurate?

  1. A Childhood ALL has survival rates under 30%
  2. B Wilms’ tumor survival rates exceed 90% in favorable cases
  3. C AML in children has better prognosis than ALL
  4. D Wilms’ tumor cannot be cured

Correct answer: Wilms’ tumor survival rates exceed 90% in favorable cases

In Wilms’ tumor, especially when caught early and with favorable histology, cure rates can approach 90 % or more.

Question 9 of 18 Hard

A child with ALL is receiving intrathecal chemotherapy for central nervous system (CNS) prophylaxis. The primary rationale is that:

  1. A Leukemia almost never involves the CNS in young children
  2. B CNS involvement is common yet hidden, so prophylaxis prevents relapse
  3. C Intrathecal drugs are given to cure an associated kidney tumor
  4. D Intrathecal therapy is used mainly to reduce leukemic bone pain

Correct answer: CNS involvement is common yet hidden, so prophylaxis prevents relapse

In childhood ALL therapy, CNS-directed treatment is required because leukemic cells can hide in the CNS and later cause relapse if not treated.

Question 10 of 18 Medium

For the nurse caring for a child post-nephrectomy for Wilms’ tumor, a priority monitoring is:

  1. A Daily weight only
  2. B Renal function of the remaining kidney and blood pressure
  3. C Limb length measurement
  4. D Hearing test only

Correct answer: Renal function of the remaining kidney and blood pressure

After nephrectomy, the remaining kidney must compensate; monitoring renal function and blood pressure is critical to detect renal insufficiency or hypertension.

Question 11 of 18 Medium

A child with AML (acute myeloid leukemia) is likely to present with:

  1. A Slowly progressing fatigue developing gradually over several months
  2. B Rapid fever, bleeding, and bone pain over days to weeks
  3. C Predominantly neurological symptoms without hematologic findings
  4. D Only a skin rash, with no change in the blood counts

Correct answer: Rapid fever, bleeding, and bone pain over days to weeks

AML in children is aggressive and presents quickly with symptoms of bone marrow failure (bleeding, infection, anemia) and bone pain.

Question 12 of 18 Medium

Which factor is considered a poor prognostic indicator in childhood ALL?

  1. A Age between 1–9 years at diagnosis
  2. B White blood cell count < 50,000 at diagnosis
  3. C Presence of central nervous system (CNS) involvement at diagnosis
  4. D Rapid early response to induction therapy

Correct answer: Presence of central nervous system (CNS) involvement at diagnosis

CNS involvement at diagnosis of childhood ALL is associated with higher risk of relapse and poorer prognosis.

Question 13 of 18 Hard

What is the hallmark pathophysiology of Wilms’ tumor?

  1. A Adult-type renal cell carcinoma in children
  2. B Nephroblastoma arising from embryonic nephrogenic rests that fail to mature
  3. C Lymphoma of kidney tissue
  4. D Transformed bladder carcinoma

Correct answer: Nephroblastoma arising from embryonic nephrogenic rests that fail to mature

Wilms’ tumor originates from embryonic kidney tissue (nephrogenic rests) that do not mature properly and progress to malignant nephroblastoma.

Question 14 of 18 Hard

A child with leukemia is at high risk for tumor lysis syndrome. The nurse understands that this is because:

  1. A The disease progresses slowly and is rarely actively treated
  2. B Rapid breakdown of cells releases potassium, phosphate, and uric acid
  3. C Only solid tumors, not blood cancers, can cause this syndrome
  4. D It is a complication seen almost exclusively in adult patients

Correct answer: Rapid breakdown of cells releases potassium, phosphate, and uric acid

In leukemia (especially acute types) rapid cell death during therapy can lead to tumor lysis syndrome with hyperkalemia, hyperphosphatemia, hyperuricemia, and risk of renal failure.

Question 15 of 18 Hard

In the staging of Wilms’ tumor, Stage V means:

  1. A Tumor confined to one kidney, completely excised
  2. B Tumor metastasized to lungs
  3. C Tumors present in both kidneys at diagnosis
  4. D Tumor spread to bone marrow

Correct answer: Tumors present in both kidneys at diagnosis

Stage V Wilms’ tumor refers to bilateral renal involvement (tumors in both kidneys) at the time of diagnosis.

Question 16 of 18 Medium

Which genetic condition increases the risk for childhood leukemia?

  1. A Beckwith-Wiedemann syndrome
  2. B Neurofibromatosis type 1
  3. C Turner syndrome
  4. D Cystic fibrosis

Correct answer: Neurofibromatosis type 1

Genetic syndromes such as Down syndrome and Neurofibromatosis type 1 (NF1) are associated with an increased risk for childhood leukemia.

Question 17 of 18 Medium

Which therapy is most important in the initial management of Wilms’ tumor?

  1. A High-dose single-agent chemotherapy used as the only treatment
  2. B Nephrectomy to remove the tumor, then chemotherapy or radiation
  3. C A wait-and-watch approach with observation for about one year
  4. D Radiation therapy alone, with no role for surgical removal

Correct answer: Nephrectomy to remove the tumor, then chemotherapy or radiation

Treatment for Wilms’ tumor typically involves surgical nephrectomy followed by chemotherapy and sometimes radiation, depending on stage and histology.

Question 18 of 18 Medium

A 4-year-old child with ALL complains of bone pain in legs and arms, is pale, has bruises and frequent fevers. The nurse recognizes that the bone pain is likely due to:

  1. A Normal growing pains that occur in healthy children
  2. B Recent over-exercise or excessive physical activity
  3. C Leukemic infiltration expanding marrow and pressing on bone
  4. D Dietary vitamin D deficiency affecting the bones

Correct answer: Leukemic infiltration expanding marrow and pressing on bone

In childhood ALL, leukemic blasts accumulate in bone marrow causing expansion, pressure, and bone pain; this is a common presenting symptom.

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