A 2-year-old male child has an asymptomatic right flank mass discovered incidentally by the mother while bathing. Suspicion of Wilms tumor is raised. Of the following, the LEAST likely investigation to be performed in this child is

Correct Answer: D

Rationale: The correct answer is D) biopsy of the mass. In the case of a suspected Wilms tumor in a pediatric patient, a biopsy of the mass is the least likely investigation to be performed initially. This is because biopsy carries the risk of causing tumor spillage and seeding, potentially complicating future surgical management. Option A) plain abdominal radiography is not the most useful imaging modality for evaluating a suspected Wilms tumor. Option B) and C) involve CT scans of the abdomen and chest, respectively, which are crucial in staging the tumor and evaluating any possible metastasis. In an educational context, it is important to emphasize the diagnostic approach in pediatric oncology. Understanding the appropriate sequence of investigations and their implications is vital for providing optimal care for pediatric patients suspected of having malignancies. Biopsy is often reserved for cases where imaging studies are inconclusive or for definitive diagnosis after surgical resection.

Correct Answer: A

Rationale: The best response for the pediatric nurse in this scenario is option A: "Let's talk about preventing and managing your asthma on a daily basis at home." This response is the most appropriate because it addresses the patient's expressed concern about repeatedly getting sick after going home and focuses on empowering the adolescent to take an active role in managing their asthma. Option B is not the best response because it deflects the conversation away from the patient and places the responsibility solely on the parents. While involving parents in asthma management is important, it is crucial to empower the adolescent to understand and take ownership of their condition. Option C, "We can arrange for you to stay in the hospital longer," is not the best response either. Prolonged hospital stays should be reserved for acute exacerbations or severe cases, and encouraging a patient to stay in the hospital longer without addressing the underlying issue may not be in the patient's best interest. In an educational context, it is essential for pediatric nurses to foster open communication with adolescent patients, validate their feelings, and empower them to actively participate in their care. By addressing the patient's concerns and involving them in the management of their asthma, the nurse can help promote self-care skills and better health outcomes for the adolescent.

Correct Answer: D

Rationale: In this question, the correct answer is D) speaks inhibition word 'no.' At 10 months old, a child typically does not yet possess the ability to use inhibition words like 'no.' This is because at this stage, infants are still in the early stages of language development and are more focused on basic communication skills. Option A) says mama or dada is correct because by 10 months old, many children are able to start saying simple words like "mama" or "dada" as part of their language development. Option B) follows one-step command without gesture is correct as well because by this age, children are usually able to understand and follow simple commands without the need for accompanying gestures. Option C) points to objects or real first word is also correct as many children at 10 months old are able to point to objects or may start saying their first real words as they continue to develop their language skills. Educationally, understanding these developmental milestones in infants is crucial for healthcare professionals and caregivers to monitor a child's growth and development. Knowing what is typical at different ages helps in early identification of any potential developmental delays or issues that may require intervention or support.

Correct Answer: D

Rationale: The correct answer is D) gives a heavy meal within an hour of bedtime. This option is not included in healthy sleep hygiene practices for children because consuming a heavy meal close to bedtime can lead to indigestion, discomfort, and disrupted sleep. It is important to avoid heavy meals, especially close to bedtime, to promote better sleep quality. Option A) setting a routine, is a key component of healthy sleep hygiene as it helps regulate the child's internal clock, making it easier for them to fall asleep and wake up at consistent times. Option B) avoiding stimulating activities like playing computer games before bedtime is important as these activities can interfere with the child's ability to wind down and fall asleep. Option C) ensuring the child spends time outside every day is beneficial for overall health and well-being, but it may not directly impact sleep hygiene as the other options do. In an educational context, teaching parents and caregivers about healthy sleep hygiene practices for children is crucial for promoting good sleep habits and overall well-being. Emphasizing the importance of a bedtime routine, avoiding stimulating activities before sleep, and ensuring a light and balanced meal are key components in helping children establish healthy sleep patterns. By understanding and implementing these practices, caregivers can support children in getting the restful sleep they need for optimal growth and development.

Correct Answer: B

Rationale: In pediatric practice, autism screening is a crucial component of developmental surveillance due to the importance of early detection and intervention in improving outcomes for children with autism spectrum disorder (ASD). The correct answer, option B) 18 to 24 months, aligns with the American Academy of Pediatrics (AAP) recommendation to conduct universal autism screening at 18 and 24 months of age. At 18-24 months, children are entering a critical period of development where early signs of ASD may become more noticeable. Screening at this age allows for timely intervention and support services to be initiated, maximizing the child's developmental progress and quality of life. Options A) 12 to 18 months and D) 36 to 48 months are incorrect because screening at 12-18 months may miss subtle early signs of ASD that become more apparent later, while screening at 36-48 months delays potential intervention during a critical developmental period. Option C) 24 to 36 months is also not ideal as it misses the opportunity for earlier intervention that can significantly impact the child's developmental trajectory. Educationally, understanding the timing and rationale behind autism screening recommendations empowers healthcare providers to implement evidence-based practices, promote early detection, and provide appropriate support for children and families. By following guidelines such as screening at 18-24 months, professionals can contribute to improved outcomes and better long-term prognosis for children with ASD.