Nokea
An 8-year-old child is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than _____ beats/min.
- A. 60
- B. 70
- C. 90
- D. 100
Correct Answer: A
Rationale: In pediatric patients receiving digoxin, the nurse should notify the practitioner and withhold the medication if the apical pulse is less than 60 beats/min in an 8-year-old child. Digoxin can cause bradycardia as a side effect, and a low heart rate (bradycardia) can indicate toxicity. Monitoring the apical pulse rate before administering digoxin is essential to ensure the child's safety and prevent complications related to digoxin toxicity.
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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.
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.
A 6-year-old male child presented with a cerebellar mass; after undergoing complete surgical resection of the mass, the histology of the mass reveals pilocytic astrocytoma. Of the following, the MOST appropriate next step in the management is
- A. radiotherapy
- B. chemotherapy
- C. observation
- D. concomitant chemo-radiotherapy
Correct Answer: C
Rationale: Pilocytic astrocytomas are generally low-grade tumors, and observation is often sufficient after complete resection.
Undescended testis is a risk factor for the development of which of the following tumors?
- A. rhabdomyosarcoma
- B. leukemia
- C. yolk sac tumor
- D. lymphoma
Correct Answer: C
Rationale: Undescended testis is a well-documented risk factor for yolk sac tumors and other testicular cancers.
Which of the following responses indicates sympathetic nervous system function?
- A. Tachycardia, dilated pupils
- B. Hypoglycaemia, headache
- C. Increased peristalsis, abdominal cramping
- D. Pupil constriction, bronchoconstriction
Correct Answer: A
Rationale: The sympathetic nervous system is responsible for the body's "fight or flight" response. Tachycardia (increased heart rate) and dilated pupils are classic responses of the sympathetic nervous system activation during times of stress or danger. These physiological responses prepare the body for action, such as running away from a threat.