A 10-mo-old boy has a left suprarenal mass. Surgery is accomplished with complete removal of the mass as well as the non-adherent lymph nodes; surgical biopsies are taken during surgery. The histology reveals poorly differentiated neuroblastoma with microscopic ipsilateral lymph nodes involvement. The contralateral lymph nodes are negative. Of the following, the BEST therapeutic approach for this infant is

Correct Answer: A

Rationale: The BEST therapeutic approach for the infant with poorly differentiated neuroblastoma and ipsilateral lymph node involvement is chemotherapy (Option A). Neuroblastoma in infants often presents as a highly malignant tumor, and chemotherapy is the primary treatment modality for disseminated disease. In this case, with microscopic lymph node involvement, systemic treatment like chemotherapy is crucial to target potential metastatic disease. Option B (radiotherapy) is not the best initial therapy for neuroblastoma in infants due to their young age and the potential for long-term side effects on developing tissues. Option C (concomitant chemo-radiotherapy) is not typically used as the primary treatment for neuroblastoma. Option D (chemotherapy followed by radiotherapy) may be considered in cases with high-risk features post-chemotherapy, but initial treatment for an infant with neuroblastoma and lymph node involvement would still be chemotherapy. Educationally, understanding the rationale behind treatment decisions in pediatric oncology is vital for nurses caring for pediatric oncology patients. Chemotherapy is often the cornerstone of treatment for pediatric malignancies, and knowing the appropriate sequencing and combination of therapies is crucial for providing safe and effective care to these vulnerable patients.

Correct Answer: A

Rationale: The most appropriate nursing intervention for preparing a preschool-aged patient for an injection is option A) allow the patient to administer an injection to a doll. This technique, known as therapeutic play, helps the child understand and become familiar with the procedure in a non-threatening way. Through play, the child can gain a sense of control and mastery over the situation, reducing anxiety and fear associated with the injection. Option B) arranging for the patient to watch a peer receive an injection may inadvertently increase the child's anxiety by witnessing another child in distress. This approach lacks the hands-on involvement and active participation that therapeutic play provides. Option C) having the parents explain the process to the patient may not be as effective as the direct experiential learning gained from administering an injection to a doll. While parental support and education are important, they may not address the child's emotional and psychological needs in the same way that therapeutic play does. Option D) suggesting diversionary activities like singing may help momentarily distract the child, but it does not actively involve the child in the preparation process or address their underlying fears and anxieties about the injection. In an educational context, understanding the rationale behind using therapeutic play in pediatric nursing is crucial for creating a supportive and effective care environment for young patients. By engaging children in hands-on learning experiences that are developmentally appropriate and non-threatening, nurses can help alleviate anxiety, build trust, and empower children to cope with medical procedures in a positive way.

Correct Answer: A

Rationale: In the context of a 6-month-old baby's visuomotor coordination, the BEST implication is the voluntary release of objects (Option A). At this age, babies are developing their fine motor skills and hand-eye coordination. The ability to voluntarily release objects signifies a key milestone in their development, indicating increasing control and coordination over their movements. Option B, comparison ability of small objects, is less relevant in this context as it pertains more to cognitive development rather than visuomotor coordination. While exploring objects (Option C) is important for sensory and cognitive development, it is not directly related to visuomotor coordination, making it a less appropriate choice in this scenario. Autonomy of actions (Option D) is a broad concept that encompasses various aspects of development and is not specific to visuomotor coordination at this age. Educationally, understanding these developmental milestones is crucial for healthcare professionals working with infants and young children. By recognizing the significance of voluntary object release in a 6-month-old, nurses and pediatric healthcare providers can assess and support the child's development appropriately. This knowledge also helps in identifying any potential delays or issues that may require early intervention.

Correct Answer: D

Rationale: The correct answer is D) sleep-onset association disorder. At 4 months old, babies start to develop sleep associations, such as needing to be rocked to sleep. This association can become a behavioral sleep disorder if the baby cannot fall asleep without being rocked. This disorder is common in infants and can lead to sleep disturbances. Option A) early signs of ADHD is incorrect because needing to be rocked to sleep at this age is more likely due to a sleep association issue rather than a sign of ADHD. ADHD typically presents with symptoms of inattention, hyperactivity, and impulsivity, not related to sleep habits. Option B) primary restless legs syndrome is incorrect as this condition is characterized by an uncomfortable sensation in the legs causing an urge to move them, usually worsened at rest and at night. It is not typically associated with needing to be rocked to sleep. Option C) sleep terrors is incorrect as sleep terrors usually occur during non-REM sleep and are more common in older children. Sleep terrors are characterized by sudden awakening with intense fear and confusion, not related to needing to be rocked to sleep. Educationally, understanding common pediatric sleep disorders is crucial for pediatric nurses as they play a vital role in assessing and supporting children's sleep patterns. Recognizing sleep-onset association disorder in infants is important for providing appropriate guidance to parents on sleep hygiene and promoting healthy sleep habits from an early age.

Correct Answer: B

Rationale: The correct answer is B) intelligence. The Denver II is a developmental screening tool used to assess children from birth to 6 years of age. It evaluates four domains: language, gross motor skills, fine motor skills, and personal-social skills. The exclusion of intelligence from the Denver II assessment is based on the fact that intelligence is a complex and multifaceted construct that cannot be reliably assessed through a brief developmental screening tool like the Denver II. Option A) language is included in the Denver II because language development is a critical aspect of a child's overall development and can indicate potential delays or issues. Option C) gross motor skills and Option D) personal-social skills are also included in the Denver II as they are essential for evaluating a child's physical and social development. In an educational context, understanding the domains assessed by tools like the Denver II is crucial for healthcare professionals working with pediatric populations. By recognizing what each domain evaluates, practitioners can better identify areas of concern, provide appropriate interventions, and support children's overall development. It also helps in collaborating with families to address any developmental delays or issues early on, enhancing the child's well-being and long-term outcomes.