Nokea
A 9-year-old boy develops acute myelogenous leukemia (AML) one year after completion of therapy for soft tissue sarcoma at his right thigh. Which of the following chemotherapeutic agents is MOST likely the cause of secondary acute myelogenous leukemia AML in this boy?
- A. cyclophosphamide
- B. vincristine
- C. etoposide
- D. doxorubicin
Correct Answer: C
Rationale: Etoposide is known to be associated with secondary AML due to its potential to induce chromosomal abnormalities.
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In fetal period, all are true EXCEPT
- A. 10 weeks - midgut returns to abdomen
- B. 12 weeks - external genitalia formed
- C. 24 weeks - surfactant production begun
- D. 26 weeks - face clearly recognizable
Correct Answer: D
Rationale: Face recognition typically occurs earlier than 26 weeks.
The age by which the child can make a tower of 9 cubes and imitates circular stroke is
- A. 24 months
- B. 30 months
- C. 36 months
- D. 42 months
Correct Answer: C
Rationale: This milestone is typically achieved around 36 months.
The major manifestation of nephrotic syndrome is:
- A. hematuria.
- B. hyperalbuminemia.
- C. edema.
- D. anemia.
Correct Answer: C
Rationale: The major manifestation of nephrotic syndrome is edema. Nephrotic syndrome is a kidney disorder characterized by increased permeability of the glomerular filtration barrier, leading to excessive protein loss in the urine. This results in low levels of protein in the blood, particularly albumin, leading to a decrease in oncotic pressure. The decreased oncotic pressure causes fluid to accumulate in the interstitial spaces, leading to edema formation. Patients with nephrotic syndrome typically present with periorbital edema, pedal edema, and ascites due to the fluid redistribution in the body. Hematuria, hyperalbuminemia, and anemia are not typically the primary manifestations of nephrotic syndrome.
A client with lung cancer develops Homer's when the tumor invades the ribs and affects the sympathetic nerve ganglia. When assessing for signs and symptoms of this syndrome, the nurse should note:
- A. Miosis, partial eyelid ptosis, and anhidrosis on the affected side of the face.
- B. Chest pain, dyspnea, cough, weight loss, and fever.
- C. Arm and shoulder pain and atrophy of arm and hand muscles both on the affected side.
- D. Hoarseness and dysphagia.
Correct Answer: A
Rationale: Homer's syndrome, also known as Horner's syndrome, is a rare condition that occurs when the sympathetic nerve supply to the eye and face is disrupted. In the case of lung cancer invading the ribs and affecting the sympathetic nerve ganglia, it can lead to Homer's syndrome. The classic triad of symptoms in Homer's syndrome includes miosis (constriction of the pupil), partial eyelid ptosis (drooping of the upper eyelid), and anhidrosis (lack of sweating) on the affected side of the face. These symptoms result from the disruption of sympathetic nerve pathways affecting the pupillary dilator muscle, the Müller muscle responsible for eyelid elevation, and sweat glands on one side of the face. Therefore, when assessing for signs and symptoms of Homer's syndrome in this client, the nurse should focus on looking for these specific manifestations.
A client was brought to the school clinic wuth severe, constant, localized abdominal pain. Abdominal muscles are rigid, and rebound tenderness is present. Peritonitis is suspected. The client is hypotensive and tachycardic. The nursing diagnosis most appropriate to the client's signs/symptoms is:
- A. fluid volume deficit related to depletion of intravascular volume
- B. altered thought process related to toxic effects of elevated ammonia levels
- C. abdominal pain related to increased intestinal peristalsis
- D. altered nutrition: less than body requirements related to malabsorption
Correct Answer: A
Rationale: The client's signs and symptoms point towards a diagnosis of peritonitis, which is an inflammation of the peritoneum lining the abdominal cavity. The presence of severe, constant abdominal pain, rigid abdominal muscles, rebound tenderness, hypotension, and tachycardia are all indicative of peritonitis. These symptoms are typically seen when there is an infection or inflammation in the abdominal cavity, leading to fluid shifting from the intravascular space to the peritoneal cavity. This shifting of fluid results in hypovolemia, causing hypotension and tachycardia.