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The parents of a child with Wilms tumor ask the nurse why surgery is necessary before a biopsy is performed. Which information should the nurse provide?
- A. Biopsy may rupture the encapsulated tumor and cause the cancer cells to spread.
- B. Metal clips are surgically applied at the tumor site for exact marking for radiation.
- C. Surgery is necessary to stage the tumor and determine metastasis to other sites.
- D. The surgery provides a visualization of other pathology and dysfunction of the kidney.
Correct Answer: A
Rationale: Biopsy risks rupturing the encapsulated Wilms tumor, potentially spreading cancer cells, making surgery the preferred initial approach.
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During a routine clinic visit, the nurse determines that a 5-year-old girl's systolic blood pressure is greater than the 90th percentile. Which action should the nurse implement next?
- A. Refer the child to the healthcare provider and schedule evaluation of blood pressure in two weeks.
- B. Measure the child's blood pressure three times during the visit and determine the highest of the readings.
- C. Conduct a head-to-toe assessment and omit repeated blood pressures during the examination.
- D. Take the blood pressure two more times during the visit and determine the average of the three readings.
Correct Answer: D
Rationale: Taking the blood pressure two more times and averaging the readings provides a more accurate assessment.
The nurse is assessing a preschool-aged child who presents with flank pain, dysuria, and low-grade fever. To determine a possible urinary tract infection, which additional information should the nurse gather from the parent?
- A. Pale urine.
- B. Increased fluid intake.
- C. New onset bedwetting.
- D. Voiding every 4 hours.
Correct Answer: C
Rationale: New onset bedwetting in a preschool-aged child can indicate a urinary tract infection, as it may reflect irritation or loss of bladder control.
The nurse is caring for a 5-week-old infant presenting with a history of projectile vomiting after feedings. Which additional finding should the nurse expect to assess?
- A. Rebound tenderness in the left lower abdominal quadrant.
- B. Stool that consists of mucus and blood.
- C. Olive-size mass in the epigastric area.
- D. Frequent burping accompanied by poor feeding.
Correct Answer: C
Rationale: An olive-size mass in the epigastric area is characteristic of pyloric stenosis, associated with projectile vomiting.
During her sports physical examination, 15-year-old female requests oral contraceptives. She explains that she is sexually active and does not want her parents to know. Which action should the nurse take?
- A. Encourage the client to discuss her need for contraceptives with her parents.
- B. Counsel the client about the risks and benefits of using oral contraceptives.
- C. Explain that she needs parental approval to receive contraceptives.
- D. Tell the client how to receive a variety of free oral contraceptives from the clinic.
Correct Answer: B
Rationale: Providing counseling about the risks and benefits of oral contraceptives ensures the client is informed and respects her autonomy and privacy while ensuring she receives necessary information.
A 6-year-old boy with bronchial asthma takes the beta-adrenergic agonist agent albuterol. The child's mother tells the nurse that she uses this medication to open his son's airway when he is having trouble breathing. What is the nurse's best response?
- A. Advise the mother that overuse of the drug may cause chronic bronchitis.
- B. Assure the mother that she is using the medication correctly.
- C. Confirm that the medication helps to reduce airway inflammation.
- D. Recommend that the mother bring the child in for immediate evaluation.
Correct Answer: B
Rationale: Using albuterol to relieve acute breathing difficulties is correct, as it relaxes airway muscles.