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: In the case of a 10-month-old boy with a poorly differentiated neuroblastoma and microscopic ipsilateral lymph node involvement, the BEST therapeutic approach is chemotherapy (Option A). The rationale behind this choice lies in the fact that neuroblastoma is a highly chemo-sensitive tumor in children. Chemotherapy is the preferred initial treatment as it can target cancer cells throughout the body, including those that may have spread beyond the primary tumor site. In this case, the microscopic lymph node involvement indicates the potential for spread, making systemic treatment like chemotherapy crucial. The other options are suboptimal for several reasons: - Radiotherapy (Option B) is generally avoided in young children due to the potential for long-term side effects on developing organs and tissues. - Concomitant chemo-radiotherapy (Option C) may be too aggressive for an infant and is not the standard of care for this type of cancer in this age group. - Chemotherapy followed by radiotherapy (Option D) is not recommended as upfront chemotherapy is the preferred initial treatment for neuroblastoma to target systemic disease. In an educational context, understanding the rationale behind treatment choices in pediatric oncology is crucial for nurses caring for pediatric cancer patients. It is essential to prioritize treatments that offer the best chance of cure while minimizing long-term side effects, especially in young patients where organ development is ongoing. This question highlights the importance of tailoring treatment plans to the specific characteristics of pediatric cancers to optimize outcomes.

Correct Answer: C

Rationale: In pediatric oncology, Acute Lymphoblastic Leukemia (ALL) is the most common type of childhood cancer. Understanding the factors that contribute to poor outcomes in children with ALL is crucial for providing effective care. Option C, hyperdiploidy chromosomal abnormality, is not associated with a poor outcome in children with ALL. In fact, hyperdiploidy is considered a favorable prognostic factor, as it is linked to a better response to treatment and improved survival rates. On the other hand, options A, B, and D are all factors that can contribute to a poor outcome in children with ALL. Children younger than 1 year or older than 10 years tend to have a less favorable prognosis due to the challenges in treatment and higher risk of complications. T-cell immunophenotype is associated with a poorer response to standard ALL therapy, leading to a higher risk of relapse. An initial leukocyte count of > 50,000 is indicative of high disease burden and is linked to a poorer prognosis. Educationally, knowing these risk factors helps healthcare providers tailor treatment plans and support strategies for children with ALL. By understanding the impact of different factors on outcomes, healthcare professionals can optimize care and improve the chances of successful treatment for their pediatric patients with ALL.

Correct Answer: A

Rationale: The correct answer is A) medulloblastoma because it is the most likely primary brain tumor to metastasize extraneurally. Medulloblastoma is an aggressive, fast-growing tumor that commonly spreads through the cerebrospinal fluid to other parts of the central nervous system and extraneural sites like bone, bone marrow, and lymph nodes. This tumor has a high propensity for dissemination to distant sites, making extraneural metastasis more common compared to other primary brain tumors. Option B) primitive neuroectodermal tumor (PNET) is not the most common tumor to metastasize extraneurally. PNETs are typically localized within the central nervous system and have a lower likelihood of extraneural spread compared to medulloblastomas. Option C) ependymoma tends to remain confined within the central nervous system and has a lower tendency for extraneural metastasis compared to medulloblastoma. Option D) malignant glioma, while aggressive and invasive within the brain, is less likely to metastasize extraneurally compared to medulloblastoma, which has a higher propensity for distant spread. Understanding the metastatic potential of different primary brain tumors is crucial for nurses caring for pediatric patients with brain tumors. Recognizing the patterns of metastasis can help nurses anticipate potential complications, provide appropriate care, and educate patients and families about the disease process and treatment options.

Correct Answer: D

Rationale: In pediatric oncology, understanding the responsiveness of different solid tumors to radiotherapy is crucial for selecting appropriate treatment modalities. In this case, the correct answer is D) osteosarcoma, as it is the least responsive tumor to radiotherapy among the options provided. Osteosarcoma is a type of bone cancer that is generally less responsive to radiotherapy due to several factors. The dense nature of bone tissue makes it more resistant to the effects of radiation compared to soft tissue tumors like rhabdomyosarcoma, neuroblastoma, and nephroblastoma. Additionally, the potential for damaging surrounding healthy tissues, growth plates, and organs in pediatric patients limits the effectiveness of radiotherapy in osteosarcoma treatment. Rhabdomyosarcoma, neuroblastoma, and nephroblastoma are more sensitive to radiotherapy due to their histological characteristics and location in soft tissues, making them more amenable to radiation treatment compared to osteosarcoma. In an educational context, this question helps reinforce the importance of understanding the varying responses of pediatric solid tumors to different treatment modalities. It highlights the need for tailored and evidence-based approaches in pediatric oncology to optimize outcomes while minimizing potential side effects and complications associated with radiotherapy.

Correct Answer: A

Rationale: In this scenario, the correct answer is option A: pH = 7.22, PCO2 = 55 mmHg, HCO3 = 30 mEq/L. Respiratory acidosis is characterized by an acidic pH (<7.35) and an elevated partial pressure of carbon dioxide (PCO2 >45 mmHg) with a normal or slightly increased bicarbonate level (HCO3 = 22-26 mEq/L). Option A aligns with these criteria as it shows a low pH, high PCO2, and an elevated HCO3 level, which is compensatory. The low pH indicates acidosis, the elevated PCO2 suggests respiratory involvement, and the increased HCO3 level indicates renal compensation. Options B, C, and D do not reflect respiratory acidosis. Option B shows a pH within normal range, a slightly elevated PCO2, and a low HCO3 level, which is not indicative of respiratory acidosis. Option C shows normal values for pH, PCO2, and HCO3, ruling out respiratory acidosis. Option D displays a normal pH, low PCO2, and a slightly elevated HCO3 level, which is not consistent with respiratory acidosis. In an educational context, understanding blood gas analysis is crucial for nurses caring for pediatric patients with respiratory issues. Recognizing the patterns seen in respiratory acidosis helps in identifying and managing respiratory distress in children. This knowledge is vital for delivering safe and effective care in pediatric nursing practice.