A 2-year-old child is being evaluated for a right flank mass; radiological appearance is consistent with rupture of Wilms tumor. The BEST therapeutic approach for this child is

Correct Answer: B

Rationale: Concomitant chemotherapy and radiotherapy are essential to manage ruptured Wilms tumor and reduce the risk of dissemination.

Correct Answer: D

Rationale: Fentanyl typically causes hypotension, nausea, and vomiting, but it does not cause acidosis.

Correct Answer: C

Rationale: Compartment syndrome is a serious condition that can occur when increased pressure within a muscle compartment impairs blood supply, leading to tissue ischemia and potential necrosis. Symptoms of compartment syndrome include severe, unrelieved pain that is disproportionate to the injury, as well as pain with passive stretch of the affected muscles. This pain is often described as deep, constant, and out of proportion to physical findings. Other signs that may indicate compartment syndrome include pallor, pulselessness, paresthesia, and paralysis, but the most specific and early sign is severe, unrelieved pain. While weak movement of the patient's toes and decreased pedal pulses can also be seen in compartment syndrome, they are not as specific or early indicators as severe, unrelieved pain.

Correct Answer: B

Rationale: Clinical reasoning is a complex cognitive process used by healthcare providers to make sound clinical decisions about patient care. It involves the gathering and analyzing of information, as well as the formulation and evaluation of potential treatment options. Clinical reasoning is purposeful in that it is driven by the goal of providing the best possible care for the patient. Healthcare providers use their knowledge, skills, and experience to systematically work through patient problems, identify possible solutions, and make informed decisions. The process is goal-directed, aiming to achieve positive health outcomes for the patient based on the best available evidence and clinical expertise.

Correct Answer: D

Rationale: Autonomic dysfunction in TBI typically involves elevated temperature, heart rate, and respiratory rate due to dysregulation of the autonomic nervous system. Lowered blood pressure is less common and may indicate hypovolemia or other conditions rather than autonomic dysfunction.