Nokea
You are discussing the risk of radiotherapy with the parents of a child with medulloblastoma; the mother has a concern about the late neurological complications post radiotherapy. The statement that should be included in the discussion that late neurological sequelae post radiotherapy is more severe with
- A. focal radiotherapy rather than craniospinal irradiation
- B. children with an age of less than 3 year
- C. concomitant chemo-radiotherapy
- D. low grade tumors rather than high grade tumors
Correct Answer: B
Rationale: Younger children (<3 years) are more susceptible to long-term neurotoxic effects of radiotherapy.
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A client with diabetes mellitus has a prescription for 5 U-100 regular insulin and 25 U of U-100 isophane insulin suspension (NPH) to be taken before breakfast. At about 4:30 p.m., the client experiences headache, sweating, tremor, pallor, and nervousness. What is the most probable cause of these signs and symptoms?
- A. Hyperglycemia
- B. Hyperuricemia
- C. Hypoglycemia
- D. Hypochondria
Correct Answer: C
Rationale: The signs and symptoms of headache, sweating, tremor, pallor, and nervousness described in the client suggest hypoglycemia, which is caused by low blood sugar levels. Insulin is a medication used to lower blood sugar levels in individuals with diabetes. In this case, the client has taken a combination of regular insulin and NPH insulin before breakfast, which could have led to a rapid drop in blood sugar levels by the afternoon causing the symptoms described. It is important to treat hypoglycemia promptly by giving the client a fast-acting carbohydrate source, such as glucose tablets or juice, to raise their blood sugar back to a safe level.
For a 14-month-old whose cleft palate was repaired 12 hours ago, which should be included in the plan of care?
- A. Allow familiar comfort items (e.g., favorite stuffed animal) and a 'sippy' cup (avoid suction items).
- B. Once liquids are tolerated, encourage a bland diet (e.g., soup, Jell-O, saltine crackers).
- C. Administer scheduled pain medication rather than PRN only.
- D. Use a Yankauer suction catheter to decrease aspiration risk.
Correct Answer: A
Rationale: Providing comfort items and avoiding suction items helps reduce distress and supports healing.
Poor prognostic factors in Hodgkin lymphoma include all the following EXCEPT
- A. age of more than 15 year at the time of diagnosis
- B. stage IV disease
- C. manifested by positron emission tomography (PET) scan positivity
- D. poor response to therapy
Correct Answer: A
Rationale: Older age is generally considered a poor prognostic factor, but not necessarily worse than other listed options.
A 10-month-old child can do all the following EXCEPT
- A. says mama or dada
- B. follows one-step command without gesture
- C. points to objects or real first word
- D. speaks inhibition word 'no'
Correct Answer: D
Rationale: Speaking inhibition words like 'no' typically occurs later.
A 16-year-old, 165-pound patient reports consuming 20-40 325-mg capsules containing acetaminophen 1 hour ago. You should
- A. measure the plasma level and determine potential toxicity from the level on the nomogram
- B. wait until 4 hours after ingestion to measure the plasma level and do nothing else
- C. administer activated charcoal immediately and measure the plasma level of acetaminophen 4 hours after ingestion
- D. send the patient home because an ingestion of this magnitude is not toxic
Correct Answer: C
Rationale: Activated charcoal can help reduce absorption of acetaminophen, and plasma levels should be measured 4 hours post-ingestion to assess toxicity using the nomogram.