A 6-year-old child complains of bilateral thigh pain, motor weakness, and some sensory deficits of both lower limbs; he has a history of bladder dysfunction over the past 2 weeks; MRI of the spinal cord shows a mass arising from the filum terminale and conus medullaris causing some pressure effect. A CNS tumor is suspected. Which of the following tumor is MOST likely arising in such site?

Correct Answer: C

Rationale: The correct answer is C) myxopapillary ependymoma. This type of tumor commonly arises from the filum terminale and conus medullaris, which are the exact locations described in the scenario. Myxopapillary ependymomas are slow-growing tumors that predominantly affect the lower spinal cord region, leading to symptoms such as lower limb weakness, sensory deficits, and bladder dysfunction, as seen in the case of this 6-year-old child. Option A) medulloblastoma is incorrect because it is a malignant embryonal tumor that typically arises in the cerebellum, not in the filum terminale or conus medullaris. Option B) anaplastic astrocytoma is incorrect as it is a type of high-grade glioma that arises from astrocytes in the brain, not in the spinal cord. Option D) choroid plexus carcinoma is incorrect because it originates from the choroid plexus within the brain ventricles, not in the spinal cord. Educationally, understanding the specific locations and characteristics of different CNS tumors is crucial for accurate diagnosis and management. This question highlights the importance of recognizing the typical presentation and site of origin of myxopapillary ependymoma in pediatric patients with spinal cord involvement.

Correct Answer: E

Rationale: In Langerhans cell histiocytosis (LCH), the organ that is LEAST likely affected is the ear. LCH is a rare disorder characterized by the overproduction of Langerhans cells in the body. These cells can infiltrate various organs and tissues, causing a range of symptoms. The skin is commonly affected in LCH, presenting as rashes, papules, or nodules. Bones are another commonly affected site, leading to bone pain, fractures, and deformities. Involvement of lymph nodes, especially the mediastinal lymph nodes, is also common in LCH. The ear, however, is less frequently affected in LCH compared to the skin, bones, and lymph nodes. While it is still possible for Langerhans cells to infiltrate the ear and cause symptoms such as otitis externa or otitis media, it is relatively less common compared to other organs. Educationally, understanding the typical organ involvement in LCH is crucial for healthcare professionals caring for pediatric patients. Recognizing the pattern of organ involvement can aid in early diagnosis and appropriate management of this condition, improving patient outcomes.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) lawyer regarding a child abuse case. This is in alignment with the Health Insurance Portability and Accountability Act (HIPAA) regulations that permit the disclosure of patient information without consent in cases of suspected child abuse. It is crucial for healthcare providers to comply with reporting requirements to protect vulnerable children from harm. Option A) consulting physician to evaluate the patient is incorrect because sharing patient information with another healthcare provider requires patient consent or a valid legal reason. Option C) school nurse to update the school records is incorrect as sharing patient information with school personnel typically requires parental consent to maintain confidentiality. Option D) teacher regarding behavioral issues is also incorrect as sharing patient information with school staff for non-medical reasons would violate patient privacy rights. Educationally, understanding HIPAA regulations is essential for healthcare professionals, especially when dealing with sensitive issues like child abuse. By knowing the exceptions to confidentiality rules, nurses can ensure they are acting ethically and legally in their practice, prioritizing the well-being of children above all else.

Correct Answer: A

Rationale: The most appropriate action in this scenario is to choose option A: reassure the mother that this is a normal phenomenon of temper tantrums. This is the correct choice because inconsolable crying episodes are common in young children, especially during temper tantrums. By providing this reassurance, the healthcare provider can alleviate the mother's worries and offer support and guidance on how to manage these episodes effectively. Option B, seeking more history regarding other skills and developmental domains, while important in a comprehensive assessment, is not the most immediate action needed in this case. The primary concern here is addressing the mother's worries and providing immediate support. Option C, referring the mother to pediatric psychiatry, is premature at this stage as inconsolable crying episodes in a 4-year-old are often within the range of normal behavior and do not necessarily indicate a need for psychiatric intervention. Option D, investigating social issues of the family, is also not the most appropriate initial action in this case. While social issues can contribute to a child's behavior, the immediate focus should be on addressing the mother's concerns and providing her with guidance and reassurance. In an educational context, it is crucial for healthcare providers to recognize common behaviors in children and provide appropriate support and guidance to parents. Understanding normal childhood development and being able to differentiate between typical behaviors and potential concerns is essential in pediatric care. By choosing option A, the healthcare provider demonstrates empathy, knowledge of child development, and the ability to effectively communicate with parents to address their concerns.

Correct Answer: B

Rationale: In pediatric development, monitoring head circumference is crucial as it reflects brain growth and overall health. The correct answer is B) 1 cm per month. During the first 3 months of life, infants typically exhibit rapid brain growth, leading to an increase in head circumference of approximately 1 cm per month. This growth rate gradually slows down as the child grows older. Option A) 0.5 cm per month is incorrect as it underestimates the expected head circumference growth rate in infants, potentially leading to missed signs of abnormal development. Similarly, option C) 1.5 cm per month and option D) 2 cm per month overestimate the normal head circumference growth rate, which could result in unnecessary parental anxiety or medical interventions. Educationally, understanding normal growth patterns in infants is essential for healthcare providers, especially nurses preparing for the NCLEX exam. By knowing the expected head circumference growth rate, nurses can accurately assess and monitor infant development, identify deviations from the norm, and intervene promptly if necessary. This knowledge ensures high-quality care and early detection of any potential issues that may arise during infancy, promoting optimal health outcomes for pediatric patients.