Nokea
You are evaluating a 6-mo-old girl with a firm right suprarenal mass. Histologically, there is no bony involvement, 10% bone marrow involvement, subcutaneous nodules involvement, and massive abdominal mass. The N-myc oncogene is not amplified. According to the international neuroblastoma staging system, the infant is stratified as
- A. stage I
- B. stage II A
- C. stage III
- D. stage IV S
Correct Answer: D
Rationale: Stage IV S refers to infants <1 year with localized primary tumor, distant metastases limited to liver, skin, or bone marrow (with <10% involvement), and no amplification of N-myc.
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By the age of 7 months, the infant is able to do all the following EXCEPT
- A. transfer object from hand to hand
- B. actively bounces
- C. uses radial palm grasp
- D. cruises
Correct Answer: D
Rationale: Cruising typically occurs later, around 9-10 months.
When doing the first assessment of a male newborn, the nurse notes that the scrotum is large, edematous, and pendulous. This should be interpreted as a(n):
- A. normal finding.
- B. hydrocele.
- C. absence of testes.
- D. inguinal hernia.
Correct Answer: B
Rationale: A hydrocele presents as a fluid-filled sac surrounding the testes within the scrotum. In newborns, it is a common finding due to the open connection between the peritoneal cavity and the scrotum that may allow fluid to accumulate. This can result in a large, edematous, and pendulous scrotum. Hydroceles are usually benign and tend to resolve on their own within the first year of life. In contrast, the absence of testes (cryptorchidism) would be identified as the inability to palpate the testes in the scrotum or inguinal canal. An inguinal hernia would present as a bulge in the inguinal area caused by a loop of intestine protruding through a weak spot in the abdominal wall.
The nurse notes vigorous bubbling in the water-seal chamber of a chest-drainage system. Which of the following actions should the nurse take to correct the bubbling?
- A. Examine the entire system and tubing for air leaks.
- B. Lower the level of suction.
- C. Nothing; vigorous bubbling is expected
- D. Ask the patient to cough forcefully.
Correct Answer: A
Rationale: The nurse should examine the entire system and tubing for air leaks when observing vigorous bubbling in the water-seal chamber of a chest-drainage system. Vigorous bubbling indicates that there is air escaping from the system, which can lead to suboptimal drainage and potential complications. By identifying and correcting any air leaks, the nurse can ensure the chest-drainage system functions effectively, allowing for proper drainage and the prevention of complications such as pneumothorax. Lowering the level of suction or asking the patient to cough forcefully would not address the underlying issue of air leaks and may not resolve the problem effectively.
Which action best explains the main role of surfactant in the neonate?
- A. Assists with ciliary body maturation in the upper airways
- B. Helps maintain a rhythmic breathing pattern
- C. Promotes clearing mucus from the respiratory tract
- D. Helps the lungs remain expanded after the initiation of breathing
Correct Answer: D
Rationale: Surfactant plays a crucial role in the neonate by helping the lungs remain expanded after the initiation of breathing. Surfactant is a substance produced by type II alveolar cells in the lungs that reduces surface tension in the alveoli. By lowering surface tension, surfactant prevents the alveoli from collapsing during expiration, thereby helping the lungs to remain expanded and functional. This function is particularly important in neonates, whose lungs are not yet fully developed and may have difficulty maintaining lung expansion without adequate levels of surfactant. Failure to produce enough surfactant can lead to respiratory distress syndrome in premature infants.
During the routine exam of an infant the parents state a 5th degree family history of adenomatous polyposis. The statement that should be included during the discussion is the infant is at increased risk of colonic adenocarcinoma
- A. the infant is at increased risk of acute lymphocytic leukemia
- B. the infant is at increased risk of intestinal Burkitt lymphoma
- C. the infant is at increased risk of hepatoblastoma
- D. the infant is at increased risk of germ cell tumor
Correct Answer: C
Rationale: Familial adenomatous polyposis significantly increases the risk of developing colorectal cancer.