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Osteosarcoma is the most common primary malignant bone tumor in children and adolescents; it has multiple subtypes and requires different modalities of treatment including surgery and chemotherapy. Of the following, the subtype of osteosarcoma which is treated by surgery alone is
- A. fibroblastic
- B. chondroblastic
- C. parosteal
- D. periosteal
Correct Answer: D
Rationale: Periosteal osteosarcoma is often treated with surgery alone if margins are clear.
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The nurse is caring for a newborn who was born 24 hours ago to a mother who received no prenatal care. The newborn is a poor feeder but sucks avidly on his hands. Clinical manifestations also include loose stools, tachycardia, fever, projectile vomiting, sneezing, and generalized sweating. Which should the nurse suspect?
- A. Seizure disorder
- B. Narcotic withdrawal
- C. Placental insufficiency
- D. Meconium aspiration syndrome
Correct Answer: B
Rationale: The clinical manifestations described in the scenario are classic signs of neonatal abstinence syndrome (NAS), which occurs in newborns who were exposed to drugs, particularly narcotics, in utero. The newborn's symptoms of poor feeding, sucking on his hands, tachycardia, fever, projectile vomiting, loose stools, sneezing, and generalized sweating are consistent with NAS. These symptoms occur as the newborn experiences withdrawal from the drugs to which they were exposed during pregnancy. In this case, the lack of prenatal care suggests that the mother may have used narcotics during pregnancy, leading to NAS in the newborn. It is essential for healthcare providers to recognize these signs and provide appropriate care and support for infants experiencing NAS.
The nurse is using the Centers for Disease Control and Prevention (CDC) growth chart for an African-American child. Which statement should the nurse consider?
- A. This growth chart should not be used.
- B. Growth patterns of African-American children are the same as for all other ethnic groups.
- C. A correction factor is necessary when the CDC growth chart is used for non- Caucasian ethnic groups.
- D. The CDC charts are accurate for US African-American children.
Correct Answer: C
Rationale: The correct statement for the nurse to consider is that a correction factor is necessary when the CDC growth chart is used for non-Caucasian ethnic groups. This is because the CDC growth charts were primarily developed using data from Caucasian children. Research has shown that children from different ethnic backgrounds may have differences in growth patterns compared to Caucasian children. Therefore, when using the CDC growth chart for African-American children or other ethnic groups, a correction factor may need to be applied to ensure accurate growth assessment and monitoring.
Which is the most appropriate nursing action when intermittently gavage-feeding a preterm newborn?
- A. Allow formula to flow by gravity.
- B. Insert tube through nares rather than mouth.
- C. Avoid letting newborn suck on tube.
- D. Apply steady pressure to syringe to deliver formula to stomach in a timely manner.
Correct Answer: C
Rationale: The most appropriate nursing action when intermittently gavage-feeding a preterm newborn is to avoid letting the newborn suck on the tube. Preterm infants are at risk for disorganized feeding patterns and can develop a non-nutritive sucking habit when the tube is in their mouth. Allowing them to suck on the tube can lead to difficulty transitioning to oral feeding once they are ready, as they may associate feeding with the tube rather than with proper suckling at the breast or bottle. Therefore, it is important to prevent non-nutritive sucking during gavage feedings to promote successful oral feeding later on.
A worried mother of a 4-year-old boy describes attacks of inconsolable crying and prefers to play alone. The MOST appropriate action is
- A. reassures her that this is a normal phenomenon
- B. seek more history regarding other skills and developmental domains
- C. refer her to pediatric psychiatry
- D. investigate social issues of the family
Correct Answer: B
Rationale: Further history is needed to rule out behavioral or psychological issues.
The nurse is taking care of a 7-year-old child with a skin rash called a papule. Which clinical finding should the nurse expect to assess with this type of skin rash?
- A. A lesion that is elevated, palpable, firm, and circumscribed; less than 1 cm in diameter
- B. A lesion that is elevated, flat-topped, firm, rough, and superficial; greater than 1 cm in diameter
- C. An elevated lesion, firm, circumscribed, palpable; 1 to 2 cm in diameter
- D. An elevated lesion, circumscribed, filled with serous fluid; less than 1 cm in diameter
Correct Answer: A
Rationale: A papule is a small, solid, elevated skin lesion that is less than 1 cm in diameter. It is usually palpable, firm, circumscribed, and can be various colors. Papules do not contain any fluid or pus. In this case, the nurse should expect to assess an elevated lesion that is firm and circumscribed, measuring less than 1 cm in diameter. This description matches option A, making it the correct choice for a papule.