Nokea
A healthy 4-year-old child has a left flank mass. Computerized tomography (CT) scan of the abdomen shows a localized renal mass. Radical nephrectomy is performed; the histology shows clear cell sarcoma of the kidney. The MOST appropriate next step in the management is
- A. CT scan of the chest
- B. CT scan of the brain
- C. bone scan
- D. magnetic resonance imaging (MRI) of the brain
Correct Answer: C
Rationale: Clear cell sarcoma of the kidney has a propensity to metastasize to bones, making a bone scan essential.
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Which finding would you expect in a 4-week-old with biliary atresia?
- A. Abdominal distention, enlarged liver and spleen, clay-colored stools, and tea-colored urine.
- B. Abdominal distention with bruises and hematuria.
- C. Yellow sclera/skin, oily skin, and prolonged bleeding times.
- D. No manifestations until advanced disease.
Correct Answer: A
Rationale: Biliary atresia typically presents with hepatosplenomegaly, pale stools, and dark urine due to impaired bile excretion.
The parent of a 7-year-old with continued bed-wetting at night says they've tried getting the child up at 11:30 p.m. Which is the best next step?
- A. There is a medication (DDAVP) that may help decrease urine volume.
- B. Be firm and show how much work is involved in changing sheets.
- C. Limit fluids in the evening and consider a reward system for dry nights.
- D. Bed-wetting alarms are available and effective.
Correct Answer: C
Rationale: Reducing evening fluids and using positive reinforcement (reward system) are effective and developmentally appropriate strategies.
How can the nurse help monitor effectiveness of therapy for the patient with a pneumothorax and chest-drainage system?
- A. Palpate for crepitus
- B. Document color and amount of sputum
- C. Auscultate lung sounds
- D. Monitor suction level
Correct Answer: C
Rationale: The nurse can help monitor the effectiveness of therapy for a patient with a pneumothorax and chest drainage system by auscultating lung sounds. Auscultation can provide information about the air movement within the lungs and any changes in lung sounds, such as decreased or absent breath sounds on the affected side, which may indicate improvement or deterioration in the patient's condition. By regularly assessing lung sounds, the nurse can track the progress of the therapy and make informed decisions about the patient's care and treatment plan. Palpating for crepitus, documenting sputum characteristics, and monitoring suction levels are important aspects of care but are not specifically focused on assessing the effectiveness of therapy for a pneumothorax.
Which of the following is the most common permanent disability in childhood?
- A. Scoliosis
- B. Muscular dystrophy
- C. Cerebral palsy
- D. Developmental dysplasia of the hip (DDH)
Correct Answer: C
Rationale: Cerebral palsy is the most common permanent disability in childhood among the options provided. It is a group of disorders that affect movement and muscle coordination due to damage or abnormal development in the brain. Cerebral palsy can occur before, during, or shortly after birth, and it is a lifelong condition that impacts a child's ability to move, maintain balance, and posture. Scoliosis, muscular dystrophy, and developmental dysplasia of the hip (DDH) are also significant conditions that can lead to disabilities in children, but they are not as prevalent as cerebral palsy in terms of permanent disabilities in childhood.
One nursing diagnosis for JRA is impaired physical mobility. Select all nursing interventions that apply.
- A. Give pain medication prior to ambulation.
- B. Assist with range-of-motion activities.
- C. Encourage the child to eat a high-fat diet.
- D. Provide oxygen as necessary.
Correct Answer: A
Rationale: Giving pain medication prior to ambulation can help alleviate discomfort and improve the child's ability to perform physical activities, thus promoting mobility.