Nokea
Which type of leukemia has been MOST likely developed in a 2-year-old child with Down syndrome in the neonatal period?
- A. ALL
- B. CML
- C. AML M1
- D. AML M6
Correct Answer: D
Rationale: Transient myeloproliferative disorder in neonates with Down syndrome can evolve into AML M6.
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The nurse is admitting a newborn with hypospadias to the nursery. The nurse expects which finding in this newborn?
- A. Absence of a urethral opening is noted.
- B. Penis appears shorter than usual for age.
- C. The urethral opening is along the dorsal surface of the penis.
- D. The urethral opening is along the ventral surface of the penis.
Correct Answer: D
Rationale: Hypospadias is a congenital condition where the opening of the urethra is located on the ventral surface of the penis instead of the tip. This results in the ventral placement of the urethral meatus compared to the normal dorsal position. It can typically be visually identified when examining the newborn's genitalia. A key characteristic of hypospadias is the abnormal positioning of the urethral opening, which distinguishes it from other conditions affecting the male genitalia.
A patient with abnormal sodium losses is receiving a house diet. To provide 1,600mg sodium daily, the nurse could supplement the patient's diet with:
- A. One beef cube and 8oz of tomato juice
- B. One beef cube and 16oz of tomato juice
- C. Four beef cubes and 8oz of tomato juice
- D. One beef cube and 12oz tomato juice
Correct Answer: D
Rationale: One beef cube typically contains about 800mg of sodium, and 8oz of tomato juice contains approximately 480mg of sodium. Therefore, to provide a total of 1,600mg of sodium daily, the nurse could supplement the patient's diet with one beef cube (800mg sodium) and 12oz of tomato juice (720mg sodium). This combination would effectively provide the required 1,600mg of sodium per day for the patient with abnormal sodium losses.
An 8-day-old is admitted with vomiting and dehydration. His HR is 170, RR is 44, BP is 85/52, and T is 99°F. The parents ask if these vital signs are normal. Which is the best response?
- A. The BP is elevated.
- B. The temperature is elevated.
- C. The heart rate is elevated; normal for a neonate is 90-160 bpm.
- D. The respiratory rate is elevated.
Correct Answer: C
Rationale: A neonatal heart rate of 170 is above the normal range (90-160 bpm), which is concerning for dehydration.
A nurse is assessing a child with an unrepaired ventricular septal defect. Which heart sound does the nurse expect to assess?
- A. Palpitations
- B. Wheeze
- C. Murmur
- D. Physiologic splitting
Correct Answer: C
Rationale: A ventricular septal defect (VSD) is a congenital heart defect characterized by a hole in the septum that separates the heart's two lower chambers (ventricles). When assessing a child with an unrepaired VSD, the nurse would expect to hear a murmur. The murmur is typically described as a harsh, holosystolic (pansystolic) murmur, best heard at the left lower sternal border. This murmur occurs due to the turbulent blood flow across the defect during systole. It is important for the nurse to recognize this characteristic murmur associated with a VSD to facilitate appropriate management and follow-up care for the child.
During a breast examination, which finding most strongly suggests that the client has breast cancer?
- A. Slight asymmetry of the breasts
- B. A fixed nodular mass with dimpling of the overlying skin
- C. Bloody discharge from the nipple
- D. Multiple firm, round, freely movable masses that change with the menstrual cycle
Correct Answer: B
Rationale: A fixed nodular mass with dimpling of the overlying skin is the finding that most strongly suggests breast cancer. This presentation is concerning for an invasive carcinoma that has invaded into the surrounding tissues, leading to the dimpling of the skin. Breast cancer typically presents as a painless, hard, irregularly shaped, non-mobile mass. Dimpling of the skin overlying the mass is a sign of advanced disease and is often associated with a poor prognosis. Therefore, this finding should raise suspicion for breast cancer and prompt further evaluation and workup.