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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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Clay is an 8-year-old boy diagnosed with heart failure. Which of the following shows that he is strictly following the directed therapeutic regimen?
- A. Daily use of an antibiotic
- B. Pulse rate less than 50 beats/minute
- C. Normal weight for age
- D. Elevation in red blood cell (RBC) count
Correct Answer: C
Rationale: In a young child like Clay who is diagnosed with heart failure, following the directed therapeutic regimen would involve maintaining a normal weight for his age. Weight monitoring is crucial in managing heart failure as excessive weight gain could lead to worsening of symptoms and complications. Ensuring that Clay stays within a normal weight range for his age shows his adherence to dietary recommendations, fluid restrictions, and overall treatment plan aimed at managing his heart failure effectively. Monitoring his weight would also help healthcare providers assess if the treatment plan is working and make necessary adjustments as needed. Therefore, Clay maintaining a normal weight for his age indicates that he is strictly following the directed therapeutic regimen for his heart failure.
When a patient participates in a research study, the pediatric nurse's primary concern is to ensure that the:
- A. parent or guardian has given verbal consent for the patient's participation.
- B. quality of care that the patient receives will not be affected if the patient chooses to withdraw from the study.
- C. research meets the developmental needs of the patient.
- D. research will directly benefit the patient.
Correct Answer: B
Rationale: Ensuring that the quality of care remains unaffected regardless of the patient's participation status is paramount to ethical research practices.
Hemolytic disease is suspected in a mother's second newborn. Which factor is important in understanding how this could develop?
- A. The mother's first child was Rh positive.
- B. The mother is Rh positive.
- C. Both parents have type O blood.
- D. RhIG (RhoGAM) was given to the mother during her first pregnancy.
Correct Answer: A
Rationale: Hemolytic disease of the newborn, also known as erythroblastosis fetalis, is a condition in which a mother's antibodies attack the red blood cells of the unborn baby. This most commonly occurs due to Rh incompatibility. The mother produces Rh antibodies during her first pregnancy with an Rh positive baby. During subsequent pregnancies with an Rh positive baby, these antibodies can cross the placenta and attack the baby's red blood cells, leading to hemolytic disease. Therefore, if the mother's first child was Rh positive, it increases the risk of hemolytic disease in subsequent pregnancies if the babies are also Rh positive.
a definitive diagnosis of sickle cell disease is based on which diagnostic result
- A. complete blood count (CBC )
- B. bone marrow aspiration
- C. blood chemistry test
- D. hemoglobin electrophoresis 128
Correct Answer: D
Rationale: A definitive diagnosis of sickle cell disease is based on hemoglobin electrophoresis. This test separates the different types of hemoglobin based on their electrical charge, allowing for the detection of abnormal hemoglobin variants such as hemoglobin S, which is characteristic of sickle cell disease. A complete blood count (CBC) can show various abnormalities seen in sickle cell disease, but it is not specific for confirming the diagnosis. Bone marrow aspiration is not routinely used for diagnosing sickle cell disease. Blood chemistry tests may reveal some complications associated with sickle cell disease but do not confirm the condition itself. Hemoglobin electrophoresis is the gold standard for diagnosing sickle cell disease by identifying the specific hemoglobin variant characteristic of the disorder.
The nurse is caring for a client in acute addisonian crisis. Which laboratory data would the nurse expect to find?
- A. Hyperkalemia
- B. Hypernatremia
- C. Reduced blood urea nitrogen (BUN)
- D. Hyperglycemia
Correct Answer: A
Rationale: In acute Addisonian crisis, the adrenal glands do not produce enough cortisol and aldosterone, leading to a decrease in blood volume and blood pressure. This can cause hyperkalemia (high potassium levels) due to the lack of aldosterone, which normally helps regulate potassium excretion from the body. Additionally, clients in Addisonian crisis may experience hyponatremia (low sodium levels) rather than hypernatremia. Reduced blood urea nitrogen (BUN) and hyperglycemia would not be typical findings in acute Addisonian crisis.