A 9-year-old boy develops acute myelogenous leukemia (AML) one year after completion of therapy for soft tissue sarcoma at his right thigh. Which of the following chemotherapeutic agents is MOST likely the cause of secondary acute myelogenous leukemia AML in this boy?

Correct Answer: C

Rationale: In this scenario, the correct answer is C) etoposide as the most likely cause of secondary acute myelogenous leukemia (AML) in the 9-year-old boy. Etoposide is a topoisomerase II inhibitor commonly associated with the development of secondary AML as a result of its genotoxic effects on hematopoietic stem cells. Cyclophosphamide (option A) is an alkylating agent known for causing bladder toxicity and secondary malignancies, but it is not the primary culprit in this case. Vincristine (option B) is a vinca alkaloid that mainly causes peripheral neuropathy and does not typically lead to secondary AML. Doxorubicin (option D) is an anthracycline known for cardiotoxicity, but it is not strongly associated with AML development. Educationally, understanding the potential long-term complications of chemotherapy agents is crucial for healthcare providers caring for pediatric oncology patients. This case underscores the importance of monitoring patients for secondary malignancies post-chemotherapy and the need for vigilant surveillance for adverse effects of specific chemotherapeutic agents.

Correct Answer: B

Rationale: The best therapeutic approach for a 2-year-old child with a ruptured Wilms tumor is concomitant chemotherapy-radiotherapy (Option B). This approach is based on current guidelines and evidence-based practice in pediatric oncology. Chemotherapy helps to shrink the tumor and make it more amenable to surgical resection. Radiation therapy is then used to target any remaining cancer cells after surgery, decreasing the risk of recurrence. This combined approach has been shown to improve outcomes and increase the chances of long-term survival in children with Wilms tumor. Option A, radiotherapy alone, is not the best choice as surgery is typically the primary treatment for Wilms tumor, and radiotherapy is usually used in conjunction with chemotherapy. Option C, another surgery, would not be the first-line approach in this case as the priority is to treat the cancer with systemic therapy before considering additional surgical interventions. Option D, observation, is not appropriate in this case as Wilms tumor is an aggressive cancer that requires prompt treatment to prevent further spread. In an educational context, understanding the rationale behind the treatment of Wilms tumor is crucial for healthcare providers caring for pediatric oncology patients. It highlights the importance of a multidisciplinary approach involving surgery, chemotherapy, and radiotherapy in achieving the best possible outcomes for children with cancer.

Correct Answer: C

Rationale: In this scenario, the correct statement to include in the discussion with parents of a 12-year-old girl diagnosed with papillary thyroid carcinoma (PTC) is that supraphysiologic levothyroxine therapy is required during long-term follow-up (Option C). This is because PTC often requires thyroid hormone replacement therapy to prevent hypothyroidism, and supraphysiologic doses may be needed to suppress thyroid-stimulating hormone (TSH) levels to reduce the risk of cancer recurrence. Option A is incorrect because PTC generally has a favorable prognosis with a high survival rate when appropriately treated. Option B is incorrect as radioactive iodine therapy is commonly used in the treatment of differentiated thyroid cancers, including PTC. Option D is incorrect because calcitonin and carcinoembryonic antigen monitoring are typically used in the management of medullary thyroid carcinoma, not PTC. Educationally, understanding the specific treatment modalities and monitoring requirements for different types of thyroid cancers is crucial for providing comprehensive care to pediatric patients. By selecting the appropriate therapy and follow-up strategies, healthcare providers can optimize outcomes and support the well-being of young patients with thyroid malignancies.

Correct Answer: A

Rationale: The correct answer is option A: ask the parent in a nonjudgmental manner about the herbs. This is the most appropriate initial action for the nurse to take in this situation. As a pediatric nurse, it is crucial to establish open and respectful communication with the patient's family. By asking the parent about the herbs in a nonjudgmental manner, the nurse can gather important information regarding what the patient may be ingesting. This information is vital for assessing potential interactions between the herbs and any prescribed medications or treatments for the acute gastroenteritis and dehydration. Option B, coordinating a nursing care conference, is not the most immediate action needed in this scenario. While discussing the patient's plan of care is important, addressing the potential use of herbs takes precedence. Option C, discussing the risks of alternative therapies with the parent, is a valuable action to take; however, it may not be appropriate as the first step. Gathering information directly from the parent should come before discussing risks. Option D, referring the family to a social worker for possible nonadherence with the healthcare regimen, is premature without first understanding the parent's actions and intentions regarding the herbs. In an educational context, this scenario highlights the importance of effective communication and assessment skills in pediatric nursing. Nurses must approach sensitive topics with empathy and without judgment to ensure the safety and well-being of the pediatric patient. It also underscores the significance of addressing complementary or alternative therapies in the overall plan of care for pediatric patients.

Correct Answer: C

Rationale: In this question, the correct answer is C) 36 months. At this age, a child typically demonstrates the developmental milestones of being able to make a tower of 9 cubes and imitate a circular stroke. The incorrect options are: A) 24 months: At 24 months, most children are still developing their fine motor skills and may not have the coordination required to build a tower of 9 cubes or imitate a circular stroke accurately. B) 30 months: By 30 months, children are progressing in their motor skills, but may still lack the precision and control needed for these specific tasks. D) 42 months: By 42 months, children would typically have mastered the ability to make a tower of 9 cubes and imitate a circular stroke, so this age is too advanced for these milestones. Educationally, understanding typical developmental milestones in children is crucial for healthcare providers working with pediatric patients. Recognizing when a child is not meeting these milestones can be an early indicator of developmental delays or potential issues that may require intervention. By knowing the expected age ranges for different skills, healthcare professionals can provide appropriate support and interventions to help children reach their full potential.