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Childhood primary brain stem tumors are a heterogeneous group of tumors; the outcome usually depends on the tumor location. Which tumor, depending on the site of tumor, carries the worst prognosis?
- A. focal dorsally exophytic
- B. cervicomedullary diffuse intrinsic
- C. none of the above
- D. diffuse intrinsic
Correct Answer: D
Rationale: Diffuse intrinsic pontine gliomas (DIPG) have the worst prognosis among brainstem tumors.
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A nurse is assessing a patient admitted for an asthma exacerbation. Which breath sounds does the nurse expect to assess?
- A. Rubs
- B. Rattles
- C. Wheezes
- D. Crackles
Correct Answer: C
Rationale: Wheezes are high-pitched, musical sounds heard during inspiration or expiration due to the constriction or narrowing of the airways, commonly associated with asthma exacerbations. The presence of wheezes indicates airway obstruction, making it the expected breath sound in a patient admitted for an asthma exacerbation. Rubs, rattles, and crackles are associated with different conditions such as pleural friction rubs, respiratory secretions, and fluid in the alveoli, respectively.
The physician writes a "now" order for codeine 45 mg IM for a patient with thrombophlebitis. The nurse has on hand 60 mg/2 mL. Which of the ff. doses should be given?
- A. 1.45 mL c.1.75 mL
- B. 1.50 mL
- C. 2.15 mL
Correct Answer: B
Rationale: To determine how many milliliters of the medication should be given, it is important to first calculate the total amount of codeine required based on the physician's order. The physician ordered codeine 45 mg IM, and the available concentration is 60 mg/2 mL. To find out the appropriate dose to administer, you can set up a proportion:
A young couple of a 2-month-old baby girl with excessive crying seeks medical advice. The LEAST important advice is to
- A. master the situation in a relaxed manner
- B. adhere to precry cues
- C. change milk formula
- D. avoid sensory overstimulation
Correct Answer: C
Rationale: Changing the milk formula is less critical unless there is evidence of intolerance or allergy.
Of the following, the WORST prognostic factor in pediatric osteosarcoma is
- A. primary pelvic bone tumor
- B. poor histologic response to treatment
- C. bony metastases at the time of diagnosis
- D. lung metastases at the time of diagnosis
Correct Answer: B
Rationale: Poor histologic response to neoadjuvant chemotherapy is a strong predictor of poor prognosis.
Hepatoblastoma is a neoplasm of undifferentiated precursors of hepatocytes. It is of different histological classification; which type predict the MOST favorable outcome?
- A. mixed type of pure epithelial and mesenchymal elements
- B. type of pure epithelial histology
- C. type of mixed fetal and embryonal histology
- D. type of undifferentiated histology
Correct Answer: B
Rationale: Pure epithelial histology, particularly fetal type, is associated with the best prognosis.