Nokea
You are evaluating a 6-year-old child with ALL on interim maintenance phase who has frequent mucositis and myelosuppression that needs frequent discontinuation of his treatment. Of the following, the MOST valuable test for this child is
- A. complete blood count
- B. pharmacogenetic testing of the thiopurine S-methyltransferase (TPMT) gene
- C. renal function test
- D. bone marrow study
Correct Answer: B
Rationale: TPMT gene testing helps determine the child's ability to metabolize thiopurine drugs, which may explain the adverse effects.
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Which discharge instruction for a child with encopresis should the nurse question?
- A. Limit milk intake.
- B. Obtain a complete dietary log.
- C. Follow up with a child psychologist.
- D. Offer a diet high in protein.
Correct Answer: D
Rationale: A high-protein diet can worsen constipation; a high-fiber, balanced diet is preferable.
A 3-day-old neonate has a large, soft, painless mass involving the head and neck region that mostly transilluminate; CT scan reveals a cystic mass involving the neck and intrathoracic mediastinum. The BEST modality for treatment of this neonate is
- A. surgical resection
- B. injection sclerosing agent
- C. laser therapy
- D. systemic interferon therapy
Correct Answer: A
Rationale: Surgical resection is the definitive treatment for cystic hygroma.
An adult has a Hickman type central venous catheter and needs to have blood drawn from it. Which of the following should the nurse do first?
- A. Use sterile technique to assemble supplies needed
- B. Aspirate and discard the first 10 ml of the blood
- C. First flush the catheter with heparinized solution, then withdraw the blood
- D. Remove the cap of the catheter and replace it with a new one
Correct Answer: C
Rationale: Before drawing blood from a central venous catheter like a Hickman type, it is essential to ensure that the catheter is patent and free of any clots. Flushing the catheter with a heparinized solution (to prevent clot formation) before withdrawing blood helps clear the catheter and ensures accurate blood sample collection. Removing clots or obstructions from the catheter is crucial to prevent complications and maintain the catheter's function. Therefore, it is important to first flush the catheter with a heparinized solution before drawing blood from it.
During starvation, the body slows metabolic processes and growth to minimize the need for nutrients. With the rapid reinstitution of feeding after starvation refeeding syndrome may occur. Of the following, the major changes that may occur with refeeding syndrome typically affect
- A. electrolytes
- B. serum proteins
- C. hormones
- D. liver enzymes
Correct Answer: A
Rationale: Refeeding syndrome primarily affects electrolytes, particularly phosphorus, potassium, and magnesium, which can become dangerously depleted due to rapid shifts in metabolism.
Which of the following statements about fluid replacement is accurate for a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS)?
- A. Administer 2 to 3L of IV fluid rapidly
- B. Administer 6L of IV fluid over the first 24 hours
- C. Administer a dextrose solution containing normal saline solution
- D. Administer IV fluid slowly to prevent circulatory overload and collapse
Correct Answer: B
Rationale: For a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS), the correct statement is to administer 6L of IV fluid over the first 24 hours (option B). The management of HHNS focuses on correcting dehydration and hyperglycemia. The initial fluid resuscitation in HHNS aims to address the profound dehydration that occurs due to osmotic diuresis from hyperglycemia. The recommended rate is to administer 1 to 1.5 L/hour of IV fluid until the patient is hemodynamically stable and urine output is adequate. Administering fluid rapidly helps to address the hypovolemia and prevent complications associated with shock. Administering fluid too slowly may delay the correction of dehydration and lead to further complications.